M.  D. 


SEP 


v  rjF 
'    "          '  LEE  "      " 


MODERN  PHYSIO-THEEAPY 


A  SYSTEM  OF  DRUGLESS  THERAPEUTIC  METHODS 


INCLUDING   CHAPTERS   ON 


X-RAY  DIAGNOSIS  AND  SUGGESTION 


BY 

OTTO   JUETTNER,    A.M.,  M.  D. 

Author  of  "Daniel  Drake  and  His  Followers";  Physician  to  Seton  Hospital, 
Cincinnati,  Ohio ;  Fellow  of   the   American  Electro-Therapeutic  Associa- 
tion,  the  American  Physio-Therapeutic   Association,   the  American 
Association  for  the  Advancement  of  Science,  the  American  Acad- 
emy of  Medicine,  the  Roentgen  Society,  London,  England; 
the  Royal  Society  of  Medicine  of  England,  the  Royal 
Microscopical  Society  of  England,  the  Royal  Anthro- 
pological Institute  of  Great  Britain  and  Ireland, 
the  Society  of  Arts,  London,  England;  the 
German  Roentgen  Society,  Berlin,  Ger- 
many ;  the  Academy  of  Medicine  of 
Mexico,  the  Societe  de  Radiol- 
ogie  et  Electrologie,  Paris, 
France,  etc.,  etc.,  etc. 


THIRD  EDITION 


KIRKSVILLE,  MO. 
W.    D.    BLEDSOE 

1913 


/r 


mg 


"Youth  fades;  love  droops;  the  leaves  of  friendship  fall : 
A  mother' s  secret  hope  otitlives  them  all.'11 

— OLIVER  WENDELL  HOLMES. 


PREFACE  TO  FIRST  EDITION. 


IN  submitting  this  book  to  the  indulgent  consideration 
of  my  readers  I  feet  disposed  to  refrain  from  giving  the 
usual  explanation  or  making  the  customary  apology.  The 
two  hundred  or  more  physicians  from  all  parts  of  the 
American  continent  whom  it  has  been  my  privilege  to  in- 
struct in  the  theory  and  practice  of  modern  therapeutic 
methods  during  the  past  three  years,  have  always  without 
exception  expressed  a  desire  to  possess  a  book  of  instruc- 
tion which  would  enable  them  to  refreshen  their  memory 
concerning  the  theoretical  but  more  especially  the  clinical 
features  of  the  work  done  at  the  CINCINNATI  POST-GRADU- 
ATE SCHOOL  OF  PHYSIOLOGICAL  THERAPEUTICS.  Thus  it 
seems  but  fair  that  those  whose  enthusiasm  for  drugless 
methods  and  good  will  for  the  author  were  instrumental 
in  the  conception  and  final  birth  of  "Modern  Physio-ther- 
apy" should  shoulder  a  large  share  of  responsibility  if  the 
progeny  should  prove  a  disappointment  to  its  parents. 

In  reproducing  my  lectures  and  demonstrations  in  book  • 
form  I  have  adhered  to  the  spirit  and  letter  of  delivery  al- 
most throughout,  if  only  to  avoid  the  dryness  and  orthodox 
"correctness"  of  a  text-book.  Physio-therapy  is — in  a  med- 
ical sense — the  living  issue  of  the  day.  Hence  the  realism 
and  fervor  of  viva  vocc  presentation  seem  appropriate. 
The  reader  may  miss  the  half-hearted,  semi-apologetic  way 
in  which  most  of  the  books  and  journals  refer  to  physiolog- 
ical methods  as  "valuable  adjuncts."  In  view  of  the  grad- 
ually waning  drug-superstition  and  the  wealth  of  light 
which  the  natural  sciences  have  shed  upon  the  theory  and 
practice  of  medicine,  physio-therapy  does  not  require  any 


6  PREFACE. 

apologies.  We  are  at  this  late  day  prepared  to  say  that 
physio-therapy  and  scientific  medical  practice  are  well- 
nigh  synonymous.  If  the  reader,  after  perusing  this  book, 
does  not  agree  with  this  statement,  the  fault  lies  with  the 
author  whose  ability  was  not  equal  to  the  subject, — never 
with  the  subject,  than  which  there  is  none  more  exacting 
as  far  as  the  knowledge,  adaptability  and  resourcefulness 
of  an  author  are  concerned.  I  imagine,  however,  that  the 
book  will  be  found  serviceable  enough  to  stimulate  further 
thought  and  study  along  physio-therapeutic  lines. 

The  concrete  conditions  of  medical  practice  give  to  the 
physiological  methods  a  place  in  the  treatment  more  espe- 
cially of  chronic  diseases.  The  general  practitioner  is  not 
so  situated  that  he  can  practice  medicine  in  a  strictly  scien- 
tific way.  He  can  only  be  a  physio-therapeutist  in  a  condi- 
tional sense.  The  modern  hospital  with  its  facilities  and 
conveniences  is  the  ideal  place  for  absolutely  pure  medical 
work  in  the  treatment  of  both  acute  and  chronic  diseases. 
At  the  bedside  of  a  hospital-patient  the  physician  need  not 
bow  to  the  prejudices,  superstition  and  ignorance  of  a  pa- 
tient's family  and  surroundings.  He  can  allow  his  scientific 
conscience  to  dominate  his  actions.  Habit,  diplomacy  and 
a  utilitarian  sense  of  making  concessions  to  the  lay-mind  are 
bound  to  influence  the  actions  of  the  general  practitioner  in 
no  small  degree.  When  these  concrete  conditions  prevail, 
physio-therapy  has  but  little  chance.  A  full  appreciation 
of  these  facts  has  influenced  the  plan  of  the  book  in  keeping 
with  the  wants  of  the  general  practitioner.  This  accounts 
for  the  great  prominence  which  has  been  given  to  the  treat- 
ment of  chronic  diseases.  Theoretically  the  book  covers  the 
entire  field  of  clinical  medicine.  There  is  no  doubt  in  the 
author's  mind  that  a  thorough  perusal,  study  and  compre- 
hension of  the  subject-matter  of  the  first  part  of  the  book, 
•more  especially  the  first  four  chapters,  ought  to  enable  any 
scientific  physician  to  elaborate  clinically  any  problem  in 
practical  medicine. 

I  trust  that  the  book  will  be  received  in  the  spirit  in 


PREFACE. 

which  it  is  offered :  as  an  earnest  effort  on  behalf  of  thera- 
peutic progress.  We  all  love  the  truth  and  try  to  find  it. 
Our  methods  of  seeking  it  may  differ.  Let  those  who  find 
fault  with  the  book,  its  plan,  aims  or  tendencies,  attribute 
its  shortcomings  to  a  defect  in  the  method  and  not  to  any 
lack  of  earnest  desire  and  sincere  effort. 

The  most  agreeable  feature  of  the  circumstances  that 
attended  the  preparation  and  final  publication  of  this  book 
is  the  lively  interest  with  which  many  of  my  brother-prac- 
titioners far  and  near  rewarded  my  humble  effort.  The 
mere  announcement  of  the  book  being  in  course  of  prepara- 
tion, culminated  in  a  veritable  avalanche  of  demands  for 
the  book,  resulting  in  the  issuance  of  a  first  edition  which 
is  four  times  as  large  as  was  originally  intended.  For  this 
display  of  interest  and  good  will  I  am  truly  grateful.  I 
hope  to  be  excused  for  a  bit  of  retrospection  which  may 
appear  personal  to  all  except  those  who  are  in  a  position  to 
know  something  about  the  true  inwardness  of  the  subject  I 
am  discussing.  My  experience  as  a  practical  exponent  of 
physio-therapeutic  medicine  has  taught  me  that  the  prac- 
tice of  modern  physio-therapy  is  not  an  unalloyed  boon. 
It  would  require  the  heroism  of  a  Galilei  to  not  be  disheart- 
ened amid  the  pitfalls  of  open  and  covert  abuse,  misinter- 
pretation and  calumny  which  beset  the  path  of  him  who 
chooses  to  pursue  the  even  tenor  of  his  own  way.  My  expe- 
rience has  been  a  repetition  of  what  has  been  the  lot  of 
others  in  my  line  of  work.  And  to  think  that  we  all — perse- 
cutor and  persecuted — are  sheltered  under  the  aegis  of  one 
great  profession  !  I  make  these  statements  on  this  auspicious 
occasion  in  order  to  encourage  those  whose  hearts  may  be 
growing  faint.  The  path  of  the  consistent  physio-thera- 
peutist is  up  hill.  Per  aspera  ad  astra!  As  long  as  purity 
of  motive  and  sincerity  of  effort  ease  the  mind  and  sweeten 
the  conscience  of  man,  the  slings  and  arrows  of  outrageous 
fortune  will  avail  nothing  against  him. 

Those  who  busy  themselves  casting  the  odium  of  char- 
latanism upon  the  practice  of  physio-therapy,  have  much  to 


8  I'KKKACK. 

learn.  In  fighting  physio-therapeutic  medicine  and  surgery 
they  imitate  their  reactionary  brethren  of  three  hundred 
years  ago  who  called  one  William  Harvey  a  quack  and  per- 
secuted him  with  all  the  venom  and  arrogance  character- 
istic of  people  of  their  ilk.  Let  the  believer  in  modern 
methods  who  is  suffering  for  a  principle,  find  comfort  and 
solace  in  the  illustrious  example  quoted. 

OTTO  JUETTNKK. 
Cincinnati,  O..  New  Year's  Day,  1906. 


PREFACE  TO  THIRD  EDITION. 


A  FEW  months  after  the  first  appearance  of  this  book 
it  became  necessary  to  issue  a  second  edition.  The  latter 
was  merely  a  reprint  of  the  first  edition.  There  were  no 
changes  or  additions  of  any  kind. 

In  presenting  this,  the  third  edition  of  "Modern  Physio- 
Therapy,"  the  author  is  grateful  for  the  uniformly  favor- 
able reception  which  has  been  accorded  his  modest  effort. 
The  remarkable  success  of  the  book  is  due  to  the  increasing 
importance  of  non-medicinal  methods.  The  preparation  of 
a  third  edition  has  given  the  author  a  chance  to  add  a 
chapter  on  "Suggestion,"  to  make  some  practical  additions 
to  the  Therapeutic  Index  and  to  revise  the  illustrations, 
many  old  ones  being  dropped  to  make  room  for  newrer  and 
better  illustrations.  It  is  to  be  hoped  that  the  book  in  its 
altered  and  improved  form  will  still  better  serve  the  great 
cause  in  the  interests  of  which  it  was  written.  Acknowl- 
edgements are  due  L.  A.  Chatterton  &  Co.,  Xew  York,  for 
kind  permission  to  reproduce  Dr.  Wm.  H.  Dieffenbach's 
splendid  radiographs  (Journal  of  Advanced  Therapeutics, 
June,  1908)  and  Dr.  H.  C.  Bennett,  Lima,  Ohio,  for  the 
loan  of  a  number  of  cuts. 

OTTO  JUETTNKR. 

CINCINNATI,  ().,  November  15,  1908. 


LIST  OF  CONTENTS. 


PART  I. 
The  Principles  of  Physiological  Therapeutics. 

CHAPTER    I.— THE    PHILOSOPHY    OF    PHYSIOLOGICAL 

THERAPEUTICS. 

Definitions. — Physio-therapy. — Physical  methods. — Physiologi- 
cal methods. — Empirical  methods. — Biological  conception  of 
medicine.' — Life. — Health. — Disease. — Vis  medicatrix  naturae. — 
Internal  causes  of  disease. — External  causes. — Mechanical 
causes. — The  rationale  of  symptoms. — Causal  symptoms. — Re- 
storative symptoms. — The  rationale  of  treatment. — Drug  illu- 
sions. 

CHAPTER  II.— PERSONAL  HYGIEXE. 

Applied  physiology. — Prophylactic  medicine. — Hygiene  as  a 
therapeutic  measure. — The  skin. — The  lungs. — The  bowels. — 
The  kidneys. — Individualization  of  general  principles. — The 
sexual  instinct. 

CHAPTER  III.— DIETETICS. 

Definitions. — Food. — Food  -  stuff. — Tissue  -  builders. — Tissue- 
destroyers. — Water. — Digestion. — Anatomical  and  physiological 
considerations. — Hygiene  and  ethics  of  food. — Influence  of  food 
upon  character  and  temperament. — Diet  as  a  therapeutic  fac- 
tor.— Uses  and  abuses  of  food. — Practical  suggestions. 

CHAPTER  IV.— THE  PHYSIOLOGICAL  EFFECTS  OF  HEAT 

AND  COLD. 

Hydrotherapy. — Historical  notes. — Physiology  of  water  applica- 
tions.— Therapeutic  indications. — Clinical  considerations. — Vari- 
ous applications. — Dry  heat. — Practical  suggestions. 

CHAPTER  V.— MECHAXO-THERAPY. 

Different  kinds  of  mechanical  therapy. — Massage. — Physiologi- 
cal considerations. — Practical  instruction. — Thure  Brandt  mas- 
sage.— Swedish  movements. — Instruments  for  massage  and 
movements.  —  Vibration.  —  Uses  and  indications.  —  Vibration 
tables. — Oscillation. 


10  LIST  OF  CONTENTS. 

CHAPTER  VI.— FORCE  AND  FORCE  MODALITIES. 

The  physics  of  force-manifestation. — Theoretical  groundwork 
of  the  subject. 

CHAPTER  VII.— THE  THERAPY  OF  LIGHT. 

Light  in  nature. — The  physics  of  light. — Finsen's  experiments. — 
The  physiological  effects  and  therapeutic  uses  of  light. — Finsen 
lamps. — Minin  lamps. — Electric  light  baths. — Chromo-therapy. 

CHAPTER  VIII.— THE  ELEMENTS  OF  ELECTRO-PHYSICS 

AND  ELECTRO-MECHANICS. 

The  rudiments  of  electrical  science. — Direct  and  alternating 
currents.  —  Voltage.  —  Amperage.  —  Resistance.  —  Induction. 
Polarity. — Electrical  terms. — Uses  of  electricity  in  medicine. — 
Galvanism. — Faradism. — Static  electricity. — High  frequency. — 
Electrodes. — Apparatus. — Technique. 

CHAPTER  IX.— THERAPEUTIC  USES  OF  GALVANIC,  FAR- 
ADIC,  STATIC  AND  HIGH  FREQUENCY  CUR- 
RENTS. 

Physiological  and  chemical  effects  of  galvanism. — Therapeutic 
indications. — Faradism. — Its  effects  and  therapeutic  uses. — Phy- 
siological effects  and  therapeutic  uses  of  static  electricity. — The 
therapy  of  currents  of  high  frequency. 

CHAPTER  X.— X-RAY  DIAGNOSIS. 

Roentgen  tubes. — The  fluoroscope. — Radiography. — Technique. 
— How  to  take  an  X-ray  picture. — The  photographic  principles. 
— How  to  interpret. — Stereo-skiagraphy. — X-ray  accessories. — 
Dangers  of  X-ray  work. 

CHAPTER  XL— THE  PRINCIPLES  AND  PRACTICE  OF  X- 
RAY  THER'APY. 

The  physics  of  the  excited  tube. — Physiological  effects  of  X- 
rays. — Technique  of  X-ray  therapy. — Clinical  indications. — Sta- 
tistics. 

CHAPTER  XII.— SUGGESTION. 

The  vast  significance  of  suggestion. — Physiological  and  psycho- 
logical considerations. — The  practice  of  mental  medication. — 
The  modus  operandi  of  suggestion. — Hypnotism. — Clinical  sug- 
gestions. 


LIST  OF  CONTENTS. 


11 


PART  II. 

The  Practice  of  Phyiological  Therapeutics. 
THERAPEUTIC  INDEX. 


Alcoholism. 

Alopecia. 

Amenorrhea. 

Anal  fissure. 

Anemia. 

Aneurysm  of  aorta. 

Angina  pectoris. 

Angioma. 

Aphasia. 

Aphonia. 

Appendicitis. 

Arterio-sclerosis. 

Asphyxia. 

Asthma. 

Autointoxication. 

Bier's  hyperemia. 

Birth-marks. 

Bright's  disease. 

Bright's      disease,      acute      and 

chronic. 
Bronchitis. 
Bruise. 
Bubo. 
Calculi. 
Cancer. 

Compressed  air. 
Chancroid. 
Chancre. 
Chilblains. 
Chorea. 
Cicatrices. 
Colon  irrigation. 
Constipation. 
Corns. 
Cough. 

Cirsoid  aneurism. 
Cystitis. 
Dandruff. 
Deafness. 
Derivation. 
Diabetes  insipidus. 
Diabetes  mellitus. 
Diarrhea. 

Diet   in   acute   fevers. 
Drug  habits. 
Drugs. 
Dysentery. 


Dysmenorrhea. 

Dyspepsia  (chronic). 

Electro-therapy. 

Emphysema. 

Endometritis. 

Enlarged  tonsils. 

Enteritis. 

Epilepsy. 

Fatty  degeneration  of  the  heart. 

Fever. 

Fibroid  tumors. 

Fistula  in  ano. 

Flexions  of  the  womb. 

Freckles. 

Functional  disorders. 

Gastric  cancer. 

Gastric  ulcer. 

Gastritis. 

Goitre. 

Gonorrhea. 

Gout. 

Granulated  eyelids. 

Headache. 

Hemorrhage. 

Hemorrhoids. 

Hepatic  cancer. 

Hepatic  cirrhosis. 

Hydrocele. 

Hypochondriasis. 

Hysteria. 

Incontinence  of  urine. 

Inflammation,  acute  and  chronic. 

Inoperable  malignant  disease. 

Insomnia. 

Intrapelvic  inflammations. 

Jaundice    (catarrhal). 

Lateral   sclerosis. 

Leucorrhea. 

Liver  spots. 

Locomotor  ataxia. 

Lupus  erythematosus. 

Lupus  vulgaris. 

Malaria. 

Melancholia. 

Meningitis. 

Menorrhaeia. 

Mctritis. 


12 


LIST  OF  CON TK NTS. 


Metrorrhagia. 

Migraine. 

Milk  secretion. 

Moles. 

Nasal   catarrh. 

Nervous  diseases. 

Neuralgia. 

Neurasthenia. 

Night  sweats. 

Obesity. 

Occupation  neuroses. 

Opsonic  therapy. 

Orchids. 

Pain. 

Palpitation  of  the  heart. 

Paralysis. 

Papilloma. 

Pelvic  adhesions  and  exudates. 

Pericarditis. 

Peritonitis. 

Pharyngitis. 

Piffard  rays. 

Pleurisy. 

Pneumonia    (lobar). 

Premature  labor. 

Prostate  gland   (enlarged). 

Pruritus  vulva?. 

Reflex  disorders. 

Rheumatism,  varieties  of. 

Rheumatoid  arthritis. 

Salpingitis. 

Sarcoma. 

Sepsis  (local). 

Sex-determination. 


Sexual  weakness. 

Singultus. 

Skin  diseases. 

Spasms. 

Sprains. 

Stenosis. 

Stiff  joints. 

Stricture. 

Sunstroke. 

Superfluous  hairs. 

Syphilis. 

Tetanus. 

Therapy  of  rest  and  recreation. 

Tobacco. 

Tonsillitis. 

Toothache. 

Tuberculosis  of  glands. 

Tuberculosis  of  joints. 

Tuberculosis  pulmonum. 

Typhoid  fever. 

Ulcer   (chronic). 

United  States   (climate  of). 

Uranium. 

Uremia. 

Uterine  inertia. 

Vaginismus. 

Valvular  diseases  of  the  heart. 

Varicose  veins. 

Versions  of  the  womb. 

Vomiting  of  pregnancy. 

X-ray  burns. 

X-ray  coil   (portable). 

X-ray  statistics. 


PART  I. 

The  Principles  of  Physiological  Thera- 
peutics. 


CHAPTER  I. 

THE   PHILOSOPHY   OF    PHYSIOLOGICAL 
THERAPEUTICS. 

"Some  few,  whose  lamp  shone  brighter,  have  been  led 
From  cause  to  cause  to  nature's  secret  head 
And  found  that  one  fixed  principle  must  be." 

— DRYDEN. 

THE;  term  "physiological  therapeutics"  (physio-therapy) 
is  used  in  centra-distinction  to  "empirical  therapeutics." 
Some  speak  of  physical  therapeutics  to  express  the  same  idea 
\vhich  physiological  therapeutics  is  supposed  to  convey. 
Practically  "physiological"  and  "physical"  refer  to  the  same 
subject-matter  in  medicine.  In  a  strictly  logical  sense,  how- 
ever, the  two  terms  are  not  synonymous. 

Physiological  therapy  (physio-therapy)  is  a  mode  of 
treatment  whose  rationale  is  suggested  by  the  laws  of 
physics  and  physiology.  The  term  "physiological,"  there- 
fore, qualifies  the  meaning  of  "therapy"  by  suggesting  the 
effect  to  be  produced. 

Physical  therapy  is  a  mode  of  treatment  by  means  of 
forces  and  agencies  that  are  physical1  in  character.  The 
term  "physical,"  therefore,  qualifies  the  meaning  of 
"therapy"  by  suggesting  Ihc  means  which  are  employed 
in  producing  physiological  or  therapeutic  effects. 

From  the  standpoint  of  purely  scientific  medicine  the 
term  "physiological"  is  distinctly  suggestive  of  a  principle. 
The  principle  is:  Therapy  must  correspond  to  and  supple- 
ment established  and  demonstrable  physiological  and  phys- 
ical phenomena.  The  term  "physical  therapy"  does  not  sug- 
gest such  a  principle.  It  simply  refers  to  certain  agencies 

1  The  word  "  physical "  is  used  synonymously  with  "mechanical." 


16  MODERN  PHYSIO-THERAPY. 

and  means  used,  irrespective  of  their  (scientific  or  empir- 
ical) character.  Physical  therapy  is  not  necessarily  phys- 
iological in  character.  Physiological  therapy  can  never  be 
empirical  while  physical  therapy  may  be.  As  stated  above, 
the  two  terms  are  used  synonymously  in  practice,  although 
they,  strictly  speaking,  do  not  convey  the  same  concept. 

The  principle  which  is  contained  in  the  term  "phys- 
iological therapy"  places  this  term  in  logical  antithesis  to 
"empirical  therapy."  If  therapeutic  phenomena  are  pro- 
duced by  a  certain  agent,  i.  e.  a  drug-preparation  of  some 
kind,  and  the  same  phenomenon  has  been  known  to  follow 
the  use  of  this  agent  at  different  times  and  in  the  hand  of 
different  observers,  the  relation  between  the  phenomenon 
following  and  the  drug-administration  preceding  is  thought 
to  be  that  of  effect  and  cause.  It  is  the  frequency  of  the 
occurrence  that  suggests  such  a  relationship.  The  relation 
is  not  explained  by  a  logical  process  of  reasoning  because 
it  can  not  be  explained  in  this  way.  After  the  drug  has 
been  administered,  there  is  a  necessary  gap  in  our  reasoning. 
We  are  expecting  something  to  happen,  because  it  has  hap- 
pened before  under  similar  circumstances.  We  'are  satis- 
fied to  note  the  -suggestive  frequency  of  the  relationship. 
This  is  the  meaning  of  empirical  or  experimental  therapy. 

The  so-called  physiological  effect  of  a  drug  is  a  deduc- 
tion from  the  empirical  phenomenon  which  is  supposed  to 
follow  the  administration  of  the  drug.  First  the  drug  is 
administered,  then  the  empirical  effect  is  noted,  and  from 
the  physical  characteristics  of  the  effect  the  physiological 
action  of  the  drug  is  deduced.  In  applying  a  physiological 
therapeutic  agent  we  know  the  physiological  effect  before 
it  takes  place,  because  we  are  familiar  with  the  laws  of 
physics  and  physiology  which  control  the  life  of  the  organ- 
it  m.  There  is  no  guess  work,  no  empiricism,  no  experiment. 
The  effect  must  follow  the  given  cause  under  given  condi- 
tions. This  is  the  meaning  of  physiological  therapy. 

Even  the  most  ardent  physio-therapeutist,  however,  will 
admit  that  the  millennium  of  absolutely  scientific  medicine 


PEULOSOPHY  OF  PHYSIOLOGICAL  THERAPEUTICS.       17 

has  not  as  yet  arrived.  That  we  have  progressed  and  that 
we  are  nearer  to  it  than  \ve  were  fifty  or  even  fifteen  years 
ago,  no  one  will  deny.  It  can  not  be  gainsaid  that  we 
avail  ourselves  of  certain  methods  to-day  that  are  purely 
scientific  and  can  not  and  should  not  be  compared  with  the 
empirical  drug-methods  of  the  past  and  present.  These 
scientific  methods  are  mechano-therapy,  hydro-therapy, 
thermo-therapy,  photo-therapy,  and  above  all  the  funda- 
mental branches  of  medical  practice,  to-wit :  hygiene  and 
dietetics.  Electro-therapy,  including  X-ray  therapy,  is  not 
on  the  same  plane  of  scientific  exactness.  Both  the  char- 
acter of  the  agent  employed  and  the  nature  of  the  effect 
produced  are  subject  to  speculation.  It  is  a  strange  fact 
that  of  all  these  modern  methods,  those  that  are  truly  scien- 
tific have  not  achieved  the  degree  of  professional  favor  and 
popular  applause  which  has  been  accorded  to  electro-  and 
radio-therapy  in  spite  of  the  markedly  experimental  char- 
acter of  the  latter. 

The  first  step  in  our  reasoning  must  be  the  clear  recog- 
nition and  statement  of  the  premises.  We  must  try  to  un- 
derstand the  subject-matter  before  we  can  grasp  its  basic 
logic  and  extraneous  relations.  What  is  meant  by  health? 
What  is  disease? 

In  viewing  the  human  body  from  its  origin  to  its  disso- 
lution through  various  stages  of  development,  the  most 
striking  feature  of  its  life  is  the  apparent  unity  of  intention 
manifested  in  the  preservation  of  the  integrity  of  the  whole 
and  in  the  mutual  co-operation  of  the  parts.  There  is  not 
only  life,  but  coincidently  the  manifest  desire  to  live  in  a 
state  of  the  highest  relative  perfection.  The  living  body 
contains  an  ever-active  principle  which  guards  the  structural 
and  functional  integrity  of  every  part  and  counteracts  within 
the  limits  of  its  potency  any  internal  or  extraneous  agencies 
which  threaten  such  integrity.  It  tends  toward  a  certain 
standard  of  well-being  under  any  and  all  circumstances. 
The  action  of  this  principle  or  vital  force,  considered  per  se, 


18  MODERN  Piivsro-Tiu  -KAPY. 


is  LiEE  itself,  —  in  its  relation  to  the  body  and  the  parts 
thereof  whose  structural  and  functional  perfection  this  force 
unceasingly  tends  to  preserve  and  restore,  it  is  HEALTH. 
Life  and  health  are,  therefore,  the  same  concept  from  two 
different  points  of  view.  In  its  efforts  to  counteract  inimical 
elements  or  to  repair  damage,  it  presents  itself  as  the  force 
\\hich  medical  men  for  want  of  a  better  name  have  desig- 
nated as  the  vis  mcdicotri.v  naturae.  The  period  of  activity 
of  this  principle  in  its  restoring  or  repairing  efforts  is  DIS- 
EASE. It  is  clear,  therefore,  that  disease  is  not  an  entity,  not 
a  something  definable,  having  clearly  marked  attributes, 
entering  the  body  in  a  certain  way,  causing  certain  disturb- 
ances and  producing  certain  ultimate  effects.  Disease  is  the 
force  or  principle  of  life  (health)  viewed  in  its  efforts  to 
protect,  preserve,  restore  or  to  repair  whenever  the  struc- 
tural or  functional  perfection  of  the  body  or  any  part  is  en- 
dangered or  impaired.  To  consider  a  disease  an  entity 
per  se  would  be  fundamentally  erroneous.  Life,  health  and 
disease  are,  to  all  intents  and  purposes,  only  different  as- 
pects of  one  and  the  same  concept. 

Let  me  interpose  that  the  activity  of  the  life-principle 
in  the  individual  body  is  analogous  to  the  action  of  a  corre- 
sponding force  which  is  manifest  in  the  existence  and  re- 
generation of  the  species.  Nature  protects  the  individual 
body  in  very  much  the  same  way  as  it  guards  the  integrity 
of  the  species  of  which  the  individual  body  is  a  part.  There 
is  the  same  uniformity  of  intention  in  the  aggregate 
(species)  as  well  as  in  the  integral  (single  body).  In  either 
there  is  the  manifest  desire  or  tendency  to  live  in  a  state  of 
relative  perfection.  The  species  demonstrates  this  tendency, 
not  only  by  propagation  of  its  integrals,  but  by  sacrificing  an 
imperfect  part  in  the  interests  of  the  whole.  This,  for  in- 
stance, is  illustrated  by  the  manner  in  which  Nature  tries 
to  prevent  the  propagation  of  syphilitic  or  tubercular  stock 
and  thus  prevents  degeneration  or  corruption  of  the  species. 
The  unhealthy  offspring  dies  in  early  childhood  or  even 
during  fetal  development.  Thus  the  integrity  of  the  species 


PHILOSOPHY  OF  PHYSIOLOGICAL  THERAPEUTICS.       19 

is  guarded.  Analogously  the  body  will  survive  at  the  ex- 
pense of  a  part, — for  instance,  in  the  case  of  a  felon.  Rather, 
than  allow  the  morbid  material  of  a  felon  to  be  absorbed  into 
the  general  circulation  and  poison  the  whole  system,  Nature 
makes  an  effort  to  isolate  the  poison,  even  if  the  suffering 
part,  e.  g.  a  phalanx,  is  destroyed  in  the  effort  of  getting 
rid  of  the  poison.  In  the  species  as  well  as  in  the  individual 
body,  the  integrity  of  the  part  is  invariably  inferior  to  the 
integrity  of  the  whole.  The  species  lives  at  the  expense  of 
the  integral,  analogously  the  body  lives  at  the  expense  of 
the  part,  the  organ  at  the  cost  of  the  cell.  It  is  the  universal 
struggle  which  ends  in  the  survival  of  the  fittest  (Darwin). 
The  "fitness"  of  the  integral  is  determined  by  a  fixed 
criterion  of  the  viability  possessed  by  the  species.  The  fit- 
ness of  the  species  as  expressed  in  the  preservation  of  its 
integrals  is  the  viability  (fitness  to  live)  of  the  integral. 
Whenever  the  fitness  of  the  part  falls  beneath  the  fitness  of 
the  whole,  the  part  as  such  ceases  to  be  viable,  i.  e.  the  part 
is  destroyed  by  a  more  or  less  rapid  process  of  dissolution. 
The  process  of  dissolution  may  extend  over  a  number  of 
generations2  before  Nature's  object,  i.  e.  to  destroy  a  de- 
teriorating member  of  the  species,  is  accomplished.  Upon 
this  fact  rests  the  biological  explanation  of  heredity,  atav- 
ism, etc.  Thus,  the  scrofulous  condition  of  an  individual 
may  be  a  part  of  a  process  of  destruction  which  began  two 
or  three  generations  ago  and  ends  in  the  extinction  of  a  non- 
viable  family.  To  the  physician  this  process  presents  itself 
as  a  state  characterized  by  lessened  or  entirely  suspended 
activity  of  the  vis  medicatri.r  nature.  There  is  no  attempt 
at  restoration  or  repair,  no  "disease"  in  the  sense  suggested 
above.  This  distinction  contains  all  the  logic  of  pathology. 
Disease  is  never  a  something  per  se,  a  something  passive  or 

2  The  same  may  be  said  concerning  qualitative  improvement  of 
the  species  as  expressed  in  the  relative  perfection  of  an  individual. 
Mental  or  physical  improvement  or  deterioration  is  a  process  which 
concerns  the  species.  The  individual  simply  typifies  a  phase  in  the 
process.  There  is  no  doubt  that  criminals  as  well  as  gentlemen 
are  made  a  hundred  years  before  they  are  born. 


20  MODERN  PHYSIO-THERAPY. 

static;  it  is  not  a  condition,  but  a  process;  not  an  accom- 
plished thing,  but  an  accomplishing  movement.  It  means 
either  return  to  normal  conditions  or  dissolution  in  parte  or 
w  toto.  Clinically  this  biological  concept  of  disease  means 
everything.  If  disease  is  a  well-planned  restorative  or  de^ 
structive  effort,  it  stands  to  reason  that  Nature  does  not  pro- 
ceed in  a  blind,  purposeless  or  haphazard  manner,  but  fol- 
lows a  certain  method.  To  define  and  understand  i.his 
method  is  the  object  of  scientific  medicine,  to  co-operate 
with  and  supplement  Nature's  method  is  the  task  of  the 
physician.  The  statements  made  convey  the  great  funda- 
mental truths  upon  which  all  rational  medicine  rests.  The 
study  of  medicine  logically  resolves  itself  into  an  analysis 
of  the  phenomena  of  life  (health  or  disease)  and  the  mode 
of  action  of  the  vital  principle  under  various  conditions. 
To  cure  disease  means  to  direct  the  activity  of  the  vital 
principle  in  its  efforts  to  bring  the  body  or  any  part  back  to 
the  normal  state  of  well-being  and  in  removing  whatever 
obstacles  might  impede  the  work  of  this  ever  active  force. 
Medicine,  therefore,  is  an  analytical  science  and  by  its  very 
essence  discountenances  any  tenets  except  those  established 
by  critical  analysis, — quod  eral  demonstrandum. 

In  the  light  of  the  statements  made  we  are  prepared  to 
look  upon  diagnosis  as  being  the  discernment,  not  of  a  con- 
dition produced  by  some  internal  or  external  cause,  but 
rather  as  being  the  recognition  of  the  cause  itself.  Biolog- 
ically the  disease-process  must  appear  to  the  physician  as 
the  effort  made  by  the  vital  principle  to  counteract  the  cause 
and  remedy  its  effects.  Logically,  therefore,  the  physician 
must  be  in  sympathy  and  in  co-operation  with  disease.  His 
province  is  to  understand  Nature's  efforts,  to  direct  them 
into  the  proper  channel  and  to  augment  them  in  keeping 
with  their  ultimate  purpose.  This  strictly  scientific  view 
of  the  subject  will  enable  us  to  construct  a  groundwork  upon 
which  we  can  erect  a  rational  system  of  medicine.  Phy- 
siological medicine  is  based  upon  facts,  not  upon  coinci- 
dences,— upon  demonstration  and  knowledge,  not  upon  as- 


PHILOSOPHY  OF  PHYSIOLOGICAL  THERAPEUTICS.       21 

sumption  and  belief.  Thus,  the  physician  must  be  a  medical 
philosopher  whose  realm  of  thought  is  bounded  only  by  the 
confines  of  truth,  and  should  not  be  hemmed  in  by  impene- 
trable walls  of  preconceived  ideas,  prejudices,  schools  and 


Since,  as  has  been  suggested,  the  knowledge  of  disease  is 
substantially  the  clear  recognition  of  the  various  causes,  and 
of  the  means  which  Nature  adopts  in  counteracting  them 
and  in  restoring  normal  conditions,  it  stands  to  reason  that 
we  must  above  all  things  try  to  identify  and  classify  these 
causes.  In  a  general  way  we  may  say  that  these  causes  are 
either  contained  in  the  organism  or  are  introduced  from 
without,  i.  e.  they  are  either  internal  or  extraneous.  We 
can  conveniently  recognize  a  third  variety,  comprising  the 
action  and  effects  of  physical  or  mechanical  forces  acting 
irpon  the  organism  from  within  and  without. 

INTERNAL  CAUSES. — The  objective  manifestation  of  life 
in  the  human  body  is  the  process  of  nutrition  by  which  all 
the  parts  of  the  body  are  kept  intact  and  normally  active. 
The  chemical  and  physiological  elements  of  the  organism 
are  constantly  regenerated  by  the  taking  up  of  correspond- 
ing material  from  without,  principally  through  the  digestive 
?nd  respiratory  organs.  These  elements  are  distributed  to 
the  body  at  large  through  the  structures  composing  the  cir- 
culatory system  (lymph-  and  blood-vessels).  Material 
which  is  unavailable  or  has  been  utilized  and  is  ready  to  be 
cast  off,  is  gotten  rid  of  by  the  excretory  organs  (lungs, 
kidneys,  bowels,  skin).  The  internal  causes  of  disease  are 
the  disorders  affecting  the  whole  or  any  part  of  this  triple 
process  of  taking  up  food-elements,  assimilating  them  and 
casting  off  waste  material.  Under  this  caption  would  come 
all  disturbances  of  nutrition,  local  and  general,  (inflamma- 
tions, active  and  passive  congestions,  anemia,  all  disturb- 
ances of  the  hematopoietic  process,  interference  with  the 
chemical  or  physiological  composition  of  the  blood,  throm- 
bus, embolus,  neuralgia,  rheumatism,  etc.,  etc.).  Most 


22  MODERN  PHYSIO-THKK .\i'v. 

nervous  diseases  belong  under  this  head  since  they  are  pri- 
marily disturbances  of  the  blood-supply  to  certain  nerves 
or  nervous  areas,  likewise  all  catarrhal  conditions.  A  sec- 
cnd  series  of  internal  causes  comprises  the  vast  number  and 
variety  of  conditions  in  which  there  is  impairment  of  phys- 
iological digestion,  assimilation  of  food-elements,  etc.,  etc. 
A  third  series  includes  all  disorders  of  excretion  (imper- 
fect or  perverted  function  of  the  skin,  kidneys  and  bowels, 
diabetes,  all  forms  of  auto-intoxication,  perhaps  all  malig- 
nant diseases,  although  the  latter  are  probably  with  more 
propriety  classifiable  under  the  head  of  increased  or  per- 
verted nutrition). 

EXTRANEOUS  CAUSES. — Under  this  head  belong  all 
causes  originating  outside  of  the  body  and  in  reality  foreign 
to  the  organism  (vegetable  and  animal  parasites,  paludal, 
chemical  and  physiological  poisons).  The  diseases  due  to 
these  extraneous  causes  are  principally  tuberculosis,  all  the 
acute  infections,  tetanus,  typhoid  and  typhus,  trichinosis, 
helminthiasis,  scabies,  tinea,  all  parasitic  diseases  of  skin 
and  mucous  membranes,  malaria,  conditions  produced  by 
chemical  poisons,  drugs  and  gases,  ptomain-infections,  etc., 
etc. 

MECHANICAL  CAUSES. — These  causes  are  agencies  oper- 
ating according  to  the  general  laws  of  physics.  All  trau- 
mata belong  under  this  head,  being  the  effect  of  the  action  of 
mechanical  forces,  i.  e.  wounds,  contusions,  the  presence  of 
foreign  bodies,  ruptures,  fractures,  luxations,  compressions, 
strangulations,  etc.,  etc.,  and  the  conditions  accompanying  or 
following  them.  Conditions  produced  by  increased,  les- 
sened or  misdirected  blood-pressure  are  included  in  this 
category,  e.  g.  the  results  of  disturbance  of  the  hepatic  or 
portal  circulation,  the  various  organic,  particularly  valvular, 
diseases  of  the  heart,  etc. 

These  causes  might  operate  singly,  successively,  or  con- 
jointly. It  devolves  upon  the  clinician  to  analyze  the  indi- 
vidual case  and  identify  the  causes  and  their  relations  to 
each  other.  Thus,  gall-stones,  being  concretions  of  one  of 


PHILOSOPHY  OF  PHYSIOLOGICAL  THERAPEUTICS.      23 

the  normal  digestive  secretions,  belong  to  the  first  variety 
of  causes.  If  they  should  obstruct  the  common  duct  and 
thus  give  rise  to  distention  of  t!:e  gall-bladder  and  to  all  its 
distressing  symptoms,  the  conditions  produced,  would  be 
classified  under  the  third  variety.  If  a  perforation  should 
occur,  giving  rise  to  a  purulent  peritonitis,  the  presence  and 
activity  of  pyogenic  organisms  would  suggest  the  second 
variety  of  causes. 

The  above  classification  is  the  first  step  toward  the  estab- 
lishment of  a  rational  pathological  method.  Biologically, 
disease  receives  its  identity  from  the  cause  or  combination 
of  causes  which  it  tries  to  correct  or  combat.  Nature  al- 
ways adapts  means  to  the  end.  We  can,  therefore,  assume 
that  the  disease-process  will  plainly  indicate  the  means 
which  Nature  adapts  to  the  end,  i.  c.  by  which  Nature  re- 
establishes normal  conditions.  Hence,  there  is  contained  in 
the  analysis  of  disease  (i)  the  clear  conception  of  a  cause 
or  a  combination  of  causes,  and  (2)  a  sharply  defined 
method  which  Nature  adopts  in  its  efforts  of  repair.  There- 
fore it  is  plain  that  the  idea  of  treatment  in  any  given  case 
is  in  reality  suggested  by  the  analysis  of  "disease"  in  con- 
nection with  recognized  laws  of  physics  and  biology,  and 
the  established  principles  of  hygiene  and  physiology.  Treat- 
ment is  to  all  intents  and  purposes  the  physician's  way  of  co- 
operating with,  augmenting  or  anticipating  Nature's  plan. 
It  is  the  logical  correlative  of  disease,  and  can,  therefore, 
never  be  vague  or  symptomatic  unless  the  physician  bluntly 
admits  his  inability  to  analyze  and,  therefore,  his  ignorance 
of  a  given  case.  In  order  to  establish  a  rational  system  of 
medicine  it  is  necessary  to  study  Nature's  bedside-method 
which  might  justly  be  called  "clinical  physiology." 

The  Rationale  of  Disease  and  Symptoms, 
^"henever  any  of  the  causes  mentioned  begin  to  act  upon 
the  organism,  either  singly  or  conjointly,  there  is  a  coinci- 
dent response  on  the  part,  not  only  of  the  structure  attacked, 
but  in  a  greater  or  less  degree  on  the  part  of  the  whole  sys- 


24  MuDKkN     I'lIYSin-TlIKKAPY. 

tern.  The  response  will  correspond  to  the  nature  of  the 
cause,  to  its  relative  speed  of  action,  to  its  intensity,  to  its 
more  or  less  continuous  character,  and  to  certain  peculiar- 
ities of  the  cause  or  causes,  or  of  the  structures  acted  upon. 
This  response  is  the  series  of  subjective  or  objective  symp- 
toms accompanying'  disease.  Symptoms  bear  the  same  rela- 
tion to  disease  (or  restorative  effort)  which  language  bears 
to  thought, — they  are  the  outward  form  of  disease,  but  not 
its  substance.  They  are  guide-posts  along  the  path  of  iden- 
tifying an  active  cause.  Biologically  there  are  two  kinds  of 
symptoms :  ( i )  Causal  symptoms,  i.  e.  those  directly  due  to 
the  activity  of  the  cause  (e.  g.  pain  caused  by  a  wound, 
dyspnea  produced  by  a  distended  stomach,  nervous  disturb- 
ances due  to  ptomain-intoxication  of  the  cerebral  centers, 
etc.)  ;  (2)  Restorative  symptoms,  i.  e.  those  produced  by  and 
accompanying  the  disease-process  proper  (elevation  of  tem- 
perature accompanying  fever,  hyperemia  coincident  with 
active  absorption,  diarrhea  following  intestinal  indigestion, 
etc.,  etc.).  The  classification  given  above  seems  scientific- 
ally exact  and  clinically  useful.  This  will  become  more  ap- 
parent as  we  progress  in  the  discussion. 

An  ordinary  case  of  typhoid  fever  will  illustrate  these 
points.  Typhoid  fever  is  due  to  an  extraneous  cause,  i.  e. 
the  entrance  into  the  organism  of  vegetable  parasites  which 
attack  the  intestinal  surface  at  certain  places  of  selection, 
giving  rise  to  ulceration  of  the  places  attacked,  and  after  en- 
tering the  general  (lymph-  or  blood-)  circulation,  either 
per  se  or  through  certain  morbid  products  generated  by 
them,  bring  about  a  condition  of  poisoning.  The  entrance  of 
the  germs  and  their  subsequent  absorption  is  the  cause, — 
Nature's  effort  to  eject  the  germs  and  their  products,  to 
heal  the  intestinal  ulcers,  and  to  repair  whatever  damage  has 
been  done,  is  the  disease.  Clinically,  typhoid  fever  presents 
an  array  of  causal  and  restorative  symptoms.  Thus,  pain 
in  the  right  iliac  region,  malaise,  mental  hebetude,  delirium 
are  causal  symptoms ;  diarrhea,  fever,  diaphoresis  are  re- 
storative symptoms.  To  the  thoughtful  observer  there  is  a 


PHILOSOPHY  ot   PHYSIOLOGICAL  THERAPEUTICS.       25 


I 

great  deal  of  logic  in  the  semeiology  of  a  condition.  Thus, 
pain  points  to  an  affected  part  and  is  Nature's  demand  for 
rest ;  anorexia  is  Nature's  warning  that  the  digestive  ap- 
paratus is  impaired.  Similar  examples  could  be  quoted  ad 
infinitiim.  Treatment  should  be  the  assistance  we  give  Na- 
ture in  its  efforts.  It  would  be  absurd  to  stand  at  the  bed- 
side and  deliberately  cover  up  a  causal  symptom  or  hide  a 
restorative  sign  without  connecting  either  with  the  element 
of  causation  or  restoration,  from  which  neither  can  logically 
be  separated.  The  distinguishing  feature  of  the  true  physi- 
cian is  not  the  euphony  of  scientific  terminology  or  depth  of 
therapeutic  resources,  but  the  intelligence  of  action.  Thus, 
fever  suggests  to  the  true  physician  Nature's  attempt  to  ac- 
celerate tissue-change  and  regenerate  the  organism  by  in- 
tensified oxidation,  the  object  being  the  elimination  of  some 
material  or  element  foreign  to  the  organism.  The  thought- 
less empiric  sees  in  the  fever,  not  the  means,  but  the  end; 
not  the  remedy,  but  the  disease.  He  aims  at  the  fever  as 
the  thing  to  be  attacked,  to  be  treated.  Incidentally  let  me 
say  that  there  is  hardly  a  subject  in  medicine  the  biology  of 
which  is  so  generally  misunderstood  and  misapplied  by  most 
physicians  as  "fever."  The  great  hydropath,  Priessnitz,  was 
wont  to  say :  "What  a  glorious  achievement  it  would  be  to 
find  a  way  of  producing  fever  and  controlling  it  as  a  reme- 
dial agent  in  the  treatment  of  chronic  diseases !  What  won- 
derful results  would  crown  our  efforts !"  Only  the  man  who 
is  a  biological  thinker  can  appreciate  the  meaning  of  this  re- 
markable statement  made  by  one  of  the  keenest  clinicians  in 
medical  history. 

It  can  not  be  repeated  too  often,  nor  impressed  too 
deeply,  that  disease  is  not  an  entity  to  be  removed  by  treat- 
ment, but  that  it  is  a  physiological  movement  toward  repair 
or  destruction  of  the  organism  or  some  special  part.  To 
treat  disease  scientifically  means  to  understand  this  move- 
ment, and  assist  it  in  taking  a  certain  course.  It  behooves 
us  now  to  apply  to  concrete  conditions  the  orinciples  con- 
veyed. 


26  MODKKN     I'llYSin-TllKRAPV. 

The  Rationale  of  Treatment. 

Before  there  can  be  any  Thought  of  helping  Nature  to 
restore  normal  conditions  it  is  essential  to  bear  in  mind  the 
general-  laws  which  govern  the  life  and  well-being  of  the 
human  body  while  normal  conditions  prevail.  These  laws 
apply  to  the  sick  body  with  even  more  force  than  to  the 
healthy  body.  They  constitute  the  groundwork  of  scientific 
medicine,  and  necessarily  take  precedence  of  any  methods 
we  might  devise,  however  rational  the  latter  might  be. 
These  fundamental  laws  which  control  the  health  of  the 
human  body  are  the  principles  of  hygiene  and  dietetics. 

Hygiene  aims  at  the  establishment  of  the  surroundings 
and  outward  conditions  which  the  human  body  requires  for 
its  well-being,  and  at  the  removal  of  deleterious  elements. 
Hygiene  provides  air  and  light  as  required  by  the  organism, 
regulates  the  periods  of  activity  and  rest  of  the  body  and 
its  parts,  inquiries  into  the  sanitary  condition  of  our  sur- 
roundings, enforces  cleanliness  of  the  surface  of  the  body, 
examines  into  the  manner  in  which  our  bodies  are  clothed, 
and  removes  all  external  influences  which  might  impair  the 
integrity  of  the  body  or  any  part.  Hygiene  is  of  supreme 
importance  to  the  body  in  the  state  of  health,  and,  therefore, 
most  emphatically  so  in  the  state  of  disease.  Hence,  the 
first  duty  of  the  scientific  physician  in  the  treatment  of  any 
diseased  condition  is  the  enforcement  of  the  fundamental 
laws  of  hygiene.  Numerous  diseased  conditions  are  due  to 
the  violation  of  hygienic  principles.  Analysis  of  the  case 
should  reveal  the  cause  and  point  to  methodical  enforcement 
of  the  law  which  has  been  violated,  as  the  logical  treatment. 
Nature  will  gladly  restore  health  if  given  a  chance  and  as- 
sisted in  an  intelligent  way. 

The  science  of  dietetics  is  likewise  of  fundamental  im- 
portance. The  physician  should  be  equally  familiar  with  the 
physiology  of  the  alimentary  canal  and  the  chemistry  of 
foods.  Since  the  stomach  performs  the  lion's  share  of  func- 
tion in  supplying  fuel  to  the  slowly  oxidizing  organism,  the 
knowledge  of  dietetics  is  of  special  import  in  all  conditions 


PHILOSOPHY  OF  PHYSIOLOGICAL  THERAPEUTICS.      27 

which  are  characterized  by  intensified  and  accelerated  oxida- 
tion (fever).  A  thorough  knowledge  of  dietetics  leads  to  a 
clear  conception  of  the  physiology  of  the  process  of  excre- 
tion (throwing  off  waste  through  the  skin,  lungs,  bowels, 
.and  kidneys),  impairment  of  which  constitutes  the  pathology 
of  not  a  few  diseases.  The  physician  having  familiarized 
himself  with  the  hygienic  and  dietetic  requirements  of  the 
healthy  human  body  is  able  to  think  physiologically  in 
adapting  any  special  mode  of  treatment  to  the  sick  body. 

In  keeping  with  our  previously  given  classification  of 
causes  of  disease  we  can  analogously  classify  the  methods  of 
treatment.  Disturbances  of  the  triple  process  of  nutrition 
(nutritive  function  of  lungs  and  alimentary  canal,  assimila- 
tion through  the  lymph-  and  blood-circulation  and  elimina- 
tion of  waste  through  the  excretory  organs)  can  be  con- 
trolled if  we  are  able  to  control  the  physiological  functions 
which  are  affected.  Thus,  if  we  are  able  to,  by  some  method, 
cause  hyperemia  or  anemia  of  any  part  of  the  body  at  will, 
we  can  certainly  control  a  disease  which  is  due  to  a  dis- 
turbance of  the  blood-supply  of  the  part.  If  the  lungs,  for 
instance,  are  hyperemic,  and  in  spite  of  nature's  effort  at  un- 
loading the  over-supply  by  absorption  or  increased  skin  ac- 
tivity, the  congestion  continues,  an  inflammatory  condition 
of  the  lung  will  be  the  result.  It  stands  to  reason  that  the 
logical  way  of  meeting  the  exigencies  of  such  a  condition  is 
to  apply  some  method  by  which  the  over-nourished  lungs 
can  be  unloaded  without  detriment  to  the  organism  at  large. 
Thus,  if  we  are  able  to  force  enough  blood  into  the  lower 
extremities  so  that  they  will  hold  three  times  the  normal 
quantity,  it  stands  to  reason  that  the  quantity  of  blood  nor- 
mally present  in  the  trunk  and  head  is  correspondingly  les- 
sened,— there  must  necessarily  follow  an  unloading  of  the 
congested  lungs.  Are  there  methods  by  which  the  circula- 
tion can  be  thus  controlled  and  diseases  due  to  internal 
causes  influenced?  Can  we  cause  hyperemia  of  an  organ 
and  thus  stimulate  its  functional  activity?  Can  we  counter- 
act a  hyperemia  and  thus  prevent,  jugulate  or  lessen  an  in- 


28  MODERN  PHYSIO-THERAPY. 

flammation?  Can  we  increase  the  activity  of  the  skin  and 
thus  encourage  excretion?  Can  we  relieve  passive  con- 
gestion? Can  we  influence  the  absorption  of  exudates? 
Can  we  accelerate,  retard,  or  modify  the  process  of  nutri- 
tion locally  and  generally?  If  there  are  methods  which  are 
capable  of  producing  these  effects,  we  are  ready  to  admit 
that  medicine  within  the  range  of  their  usefulness  is  a 
science.  To  illustrate  these  points  let  us  refer  to  some  of 
these  strictly  physiological  methods  in  their  practical  appli- 
cation at  the  bedside.  By  way  of  contrast,  let  me  briefly 
discuss  the  subject  of  empiricism,  both  as  a  part  of  rational 
medicine  and  as  a  species  of  charlatanism. 

Empirical  Methods. 

By  empirical  methods  are  meant  modes  of  treatment 
based  upon  experience  without,  however,  admitting  of 
demonstration  of  their  modus  opcrandi.  The  relative  value 
of  an  empirical  method  is  determined  (i)  by  the  regularity 
with  which  an  effect  follows  the  activity  of  a  certain  cause, 
e.  g.  the  administration  of  a  certain  drug,  and  (2)  by  the 
degree  of  knowledge  we  have  concerning  the  effect  in  all  its 
aspects.  Thus,  if  we  administer  quinin  to  a  malarial  pa- 
tient, and  produce  a  decided  effect,  even  to  the  extent  of 
causing  morphologically  destructive  changes  in  the  plas- 
ir.odium,  we  might  consider  this  effect  a  propter  hoc  as  well 
as  post  hoc.  Yet  this  method  is  not  a  physiological  one,  be- 
cause while  we  can  connect  cause  and  effect  we  can  not 
define  the  connection.  What  becomes  of  the  quinin  after 
absorption,  what  chemical  changes  it  undergoes,  what  chem- 
ical and  physiological  elements  of  the  organism  it  affects, 
how  it  affects  them,  its  modus  opcrandi  in  disintegrating  the 
piasmodium,  we  can  not  demonstrate. 

To  practically  illustrate  the  distinction  between  a  phy- 
siological and  an  empirical  method  let  us  consider  the  case 
of  a  patient  who  is  suffering  from  a  severe  congestive  head- 
ache. If  we  give  this  patient  a  moist  pack  from  the  feet 
to  the  costal  border  and  find  the  patient  within  a  few  min- 


PHILOSOPHY  OF  PHYSIOLOGICAL  THERAPEUTICS.      29 


utes  relieved  of  his  pain  and  ready  to  fall  asleep,  we  are 
fully  conscious  of  the  physiological  process  through  which 
this  effect  was  produced.  Dilatation  of  the  vessels  of  the 
region  packed  is  followed  by  contraction  of  the  cerebral  and 
meningeal  vessels  (Schiiller's  classical  experiment  with 
rabbits).  The  effect  is  a  lowering  of  intracranial  blood- 
pressure  and  a  cerebral  anemia.  The  result  is  relief  and 
somnolence.  This  is  the  clinical  application  of  a  physiolog- 
ical method.  If,  instead  of  being  treated  according  to  the 
above  plan,  the  patient  is  given  ten  grains  of  phenacetin 
and  should  find  himself  relieved,  the  therapist  would  tell  us 
that  coal-tar  products  depress  the  heart  and  thus  lower  the 
biood-pressure,  -Hence  the  relief.  How  the  effect  is  pro- 
duced, is  subject  to  physiological  speculation.  The  therapist 
has  seen  the  same  effect,  with  more  or  less  promptness  and 
intensity,  follow  the  'administration  of  the  drug.  His  state- 
ment is  a  generalization  of  a  proposition  based  upon  re- 
peated experience.  He  associates  effect  and  cause,  but  does 
not  and  can  riot  define  the  nature  of  the  association.  He 
presumes,  but  he  can  not  demonstrate.  After  producing  the 
effect  he  assumes  a  physiological  modus  opcrandi  instead  of 
demonstrating  the  physiological  action  in  its  various  rela- 
tions to  the  organism,  and  then  letting  the  clinical  effect  fol- 
low as  a  necessary  sequence,  just  as  a  conclusion  follows  its 
premises.  In  regard  to  the  moist  pack  the  conclusion  (clin- 
ical effect)  follows  the  premises  (physiological  demonstra- 
tion). Every  link  of  the  argument  is  complete  and  clearly 
set  forth.  The  action  of  the  moist  pack  upon  the  skin,  upon 
the  cutaneous  vessels,'  upon  the  subcutaneous  structures,  can 
be  seen  and  measured  by  the  senses  and  by  physiological 
instruments  (Schiiller's  experiments  on  rabbits,  Goltz's  ex- 
periments on  frogs,  Winternitz's  observations  on  animals 
and  patients,  Ludwig's  investigations  concerning  the  "ther- 
mic" sense  of  blood-vessels,  etc.,  etc.).  Xot  so  in  regard  to 
phenacetin  or.  for  that  matter,  any  drug  taken  internally. 
What  becomes  of  the  drug  after  absorption,  what  path  it 
takes,  what  chemical  changes  it  undergoes,  what  physiolog- 


30  MODF.KX  PHYSIO-THERAPY. 

ical  elements  it  attacks,  how  the  organism  a?  a  whole  and  in 
its  parts  responds  to  the  presence  of  the  foreign  substance, 
— all  these  are  uncertain,  ill-defined  links  in  our  argument. 
As  long  as  they  are,  the  use  of  drugs  can  not  rise  to  the 
dignity  of  a  scientific  or  physiological  method.  The  cause 
may  be  clear,  the  effect  may  be  distinct  and  characteristic, 
yet  the  method  is  empirical  as  long  as  the  nexus  causalis 
is  a  physiological  speculation  only. 

The  internal  administration  of  drugs  is  an  art  and  not  a 
science.  Drug  methods  can  never  be  free  from  uncertainty 
and  doubt.  Yet,  while  drugs  do  not  cure  or  heal,  they  are 
frequently  capable  of  relieving  certain  urgent  symptoms 
without  detriment  to  the  organism.  Even  then  they  are 
at  best  but  necessary  evils.  The  longer  we  practice,  the 
more  skeptical  we  become  in  regard  to  the  materia  medica. 
The  scientific  physician  prescribes  little  and  rarely.  The 
gun-shot  prescription  is  notoriously  an  indication  of  an  un- 
scientific mind,  for  the  intelligent  physician  tries  to  be  exact 
and  to  the  point  even  in  his  symptomatic  therapy. 

Materia  medica  is  the  least  important  branch  of  medical 
teaching  because  it  contributes  the  smallest  share  to  scien- 
tific medicine.  It  owes  its  prominence  to  the  efforts  of  those 
\\ho  make  their  school  or  pathy  or  ism  the  criterion  of 
scientific  medicine  instead  of  proceeding  lice  versa.  Its 
empirical  character  caused  Mephisto  to  utter  his  caustic 
criticism  about  doctors  and  their  work: 

"The  work  of  doctors  is  not  hard  to  grasp ; 

They  rack  their  brains,  and  study  high  and  low; 
Yet  in  the  end  the  sick  get  well  or  gasp 
Their  last,  if  Mother  Nature  wills  it  so." 

(Goethe's  Faust.) 

In  view  of  the  vast  amount  of  quackery  which  is  prac- 
ticed at  the  bedside  under  the  guise  of  therapeutics,  would 
that  the  last  two  lines  of  Mephisto's  remarks  were  true! 
What  a  boon  it  would  be  to  suffering  humanity  to  be  left 
expectantly  alone  and  at  the  tender  mercies  of  ever-merciful 


PHILOSOPHY  OF  PHYSIOLOGICAL  THERAPEUTICS.       31 

Nature !  Xature  is,  indeed,  generous  and  indulgent  to  a 
fault.  The  poor  typhoid-fever  patient  who  for  weeks  has 
been  persistently  dosed  wyith  some  coal-tar  product,  survives, 
though  his  blood  has  been  subjected  to  constant  deoxidation 
and  his  red  blood-corpuscles  have  been  destroyed  in  vast 
numbers.  His  heart  bears  up  under  the  double  burden  of 
the  fever-process  and  the  drug-depression.  Nature  opens 
up  the  pores  of  the  patient's  skin  to  eject  the  offensive  sub- 
stance. The  patient  finally  recovers,  in  spite  of  the  so-called 
treatment, — an  anemic  or  even  cyanotic  semblance  of  his 
former  self.  This  kind  of  empiricism  savors  of  blatant 
quackery.  Even  from  the  standpoint  of  symptomatic  treat- 
ment it  is  totally  unjustifiable. 

It  is  plain  that  -the  external  use  of  chemical  agents  is 
not  open  to  these  objections  because — cceteris  paribus — 
their  modus  opcrandi  or  rather  medendi  can  be  made  as 
clear  and  logical  as  any  laboratory-experiment,  e.  g.  the  use 
of  silver  nitrate  on  a  mass  of  unhealthy  granulations  or  the 
application  of  a  solution  of  corrosive  sublimate  to  an  ex- 
posed surface  representing  an  immense  culture-bed  of  pus- 
producers.  The  action  of  these  purely  chemical  agents  is 
\\ell-defined,  and  for  this  reason  is  a  logical  major  premise 
in  the  argument.  The  minor  premise  is  the  clinical  prob- 
lem to  be  solved.  If  the  reasoning  of  the  physician  in  regard 
to  the  existing  state  of  affairs  is  as  sound  as  the  logic  pre- 
sented by  the  drug-agent  and  its  chemical  and  physiological 
potency,  the  conclusion,  i.  e.  the  treatment  adopted,  must 
be  correct.  Such  a  therapeutic  method  is  physiological. 
Internal  medication  can  never  be  a  logical  argument  of  this 
kind,  because  both  premises  are  incomplete.  This  reason 
accounts  for  the  notorious  discrepancy  of  opinions  among 
doctors  in  regard  to  internal  medication.  The  chemical  use 
of  drug-agents  is  subject  to  analysis  and  is,  for  this  reason, 
never  a  bone  of  contention.  The  physiological  therapeutist 
aims  at  a  complete  and  thoroughly  correct  clinical  syllogism. 
Drug-therapy  can  not  be  logical  in  this  sense.  Any  sub- 
stance that  enters  the  organism  through  the  channels  of 


32  MODERN   PHYSIO-THERAPY. 

r.ssimilation  must  necessarily  be  either  a  food  or  a  poison. 
There  is  no  other  alternative.  That  which  is  supposed  to  be 
a  physiological  effect,  e.  g.  the  diaphoretic  action  of  jabo- 
randi  or  the  cathartic  effect  of  calomel,  is  nature's  means  of 
getting  rid  of  a  poisonous  substance.  That  drugs  are  capa- 
ble of  producing  effects  on  the  system,  no  one  questions. 
All  poison?  have  some  sort  of  action.  The  fallacy  of  drug- 
medication  consists  in  the  assumption  that  these  ill-defined 
and  ever-variable  drug-effects  are  curative  in  the  sense  of 
influencing  a  disease-process  physiologically.  Thus,  the 
physiological  therapeutist  establishes  the  same  criterion  for 
all  agents  that  are  used  in  the  treatment  of  disease.  In 
availing  himself  of  the  poisonous  effects  of  some  drugs  he 
chooses  the  lesser  of  two  evils,  c.  g.  he  prefers  a  mild  de- 
gree of  opium-poisoning  to  severe  suffering.  This  is  a 
mode  of  action  which  the  concrete  conditions  of  practice  re- 
quire, e,  g.  the  anodyne  action  of  morphin,  the  anaesthesia 
produced  by  chloroform-poisoning,  the  parasiticidal  action 
of  antiseptics,  anthelminthics  etc.  The  argument  between 
physiological  and  purely  empirical  (drug-)  methods  refers 
to  their  relatively  curative  action  in  influencing  a  patholog- 
ical process,  using  the  word  "curative"  in  its  most  exacting 
physiological  sense. 

Physiological  Methods. 

Among  the  methods  which  are  in  accord  with  biological 
reasoning  and,  therefore,  might  be  designated  as  being 
strictly  scientific,  hydro-therapy  occupies  a  most  conspicuous 
place  and  may  well  serve  as  a  type  for  illustration.  In  order 
to  illustrate  the  theoretical  points  of  our  discussion  about 
the  rationale  of  physiological  methods,  I  shall  confine  my- 
self to  pointing  out  the  salient  features  of  hydrotherapeutics 
as  a  typical  physiological  method. 

Water  as  a  carrier  of  temperature  is  the  agent  par  ex- 
cellence by  which  we  can  control  at  will  the  circulation  of 
the  whole  body  and  of  any  part.  By  exposing  the  surface 
of  the  body  to  the  action  of  cold  (heat)  we  can  cause  a 


PHILOSOPHY  OF  PHYSIOLOGICAL  THERAPEUTICS.      33 

condition  of  cutaneous  anemia  (hyperemia)  and  coinci- 
dently  a  congestion  (depletion)  of  the  deep  vessels.  Like- 
wise, we  can  by  increasing  the  blood-supply  of  any  special 
part  cause  a  corresponding  decrease  in  some  other  part. 
Goltz  has  shown  that  it  is  possible  to  almost  entirely  de- 
plete the  head  and  the  extremities  and  crowd  all  the  blood 
into  the  abdominal  vessels.  The  strictly  physiological  ac- 
tion upon  the  sensory  cutaneous  nerves,  and  through  these 
upon  the  central  and  peripheral  ganglia  controlling  the  vaso- 
motors  and  thus  upon  the  muscular  coat  of  the  cutaneous 
blood-vessels,  necessarily  affects  the  process  of  nutrition,  of 
tissue-change  (oxidation),  of  absorption  and  excretion.  By 
hydrotherapeutic  means  we  can  arbitrarily  accelerate  or  re- 
tard these  processes,  both  locally  and  generally.  An  in- 
flammatory process  in  any  part  of  the  body  can  be  acted 
upon  in  any  stage.  During  the  stage  of  congestion  it  can 
be  aborted  or  jugulated  by  drawing  the  blood  into  some  dis- 
tant part,  thus  depleting  the  affected  area  and  depriving 
the  inflammatory  process  literally  of  its  working  capital. 
In  cases  in  which  the  stage  of  congestion  is  over  and  active 
inflammation  has  been  established,  the  hydrotherapist  again 
avails  himself  of  the  "derivating"  action  of  water,  and  con- 
trols the  severity  of  the  process  by  carrying  off  the  surplus 
blood  crowding  in  upon  the  inflamed  area.  By  acting  upon 
the  surface  of  the  whole  body  he  causes  the  body  to  oxidize 
more  rapidly  and  absorb  and  excrete  the  products  of  inflam- 
mation. Thus  he  intensifies  the  action  of  Nature's  great- 
est restorative  agent,  the  fever-process  proper.  The  phys- 
iological constituents  of  the  body  are  regenerated,  proving 
that  water  after  all  is  directly  the  great  alterative  or  blood- 
purifier.  .  To  be  able  to  arbitrarily  control  the  quantity  of 
blood  and  the  rapidity  of  circulation  in  any  part,  means  to 
be  able  to  control  nutrition,  to  relieve  active  and  passive  con- 
gestion, to  promote  the  metamorphosis  of  tissue,  to  encour- 
age absorption  and  excretion.  The  vast  usefulness  of  "de- 
rivating" water-applications  can  be  best  appreciated  when 
we  compare  the  results  we  achieve,  with  the  uncertainties 


34  MODERN    I'IIYSIO-TIIKKAPY. 

and  disappointments  of  drug-medication,  especially  in  the 
treatment  of  chronic  diseases,  e.  g.  such  conditions  as 
chronic  rheumatism,  malaria,  abdominal  plethora,  etc.,  etc. 
The  marvelous  effect  of  water-applications  is  emphasized 
by  such  an  authority  as  Henoch,  who  quotes  the  following1 
interesting  case  of  a  gastric  neurosis  in  this  connection :  A 
lady  whose  stomach  would  not  retain  any  food  and  even  re- 
jected water,  was  given  up  to  die.  A  last  attempt  at  treat- 
ment was  made  by  a  French  hydrotherapist,  who  immersed 
the  patient's  feet  up  to  the  knees  in  hot  water  and  applied  a 
(cold)  Kneippdouche  to  the  head.  The  effect  was  remark- 
able. The  sensory  gastric  nerves,  which  had  been  irritated 
by  the  passive  congestion  in  the  walls  of  the  stomach,  and 
perhaps,  too,  by  the  endless  number  and  variety  of  drugs  ad- 
ministered, became  quiet  in  consequence  of  the  "derivating" 
and  the  reflex  sedative  effect  of  the  water-applications.  The 
lady  made  a  prompt  recovery. 

That  the  therapy  of  water  has  received  so  little  atten- 
tion from  the  majority  of  the  profession  is,  in  view  of  the 
strictly  scientific  character  of  the  method,  somewhat  sur- 
prising. With  the  exception  of  the  cold  sponge-bath,  the 
moist  pack,  and  the  hot-water  immersion-bath  in  surgery, 
physicians  know  very  little  about  water  and  its  universal  ap- 
plicability and  efficacy.  And  yet,  as  a  remedial  agent,  it  is 
infinitely  superior  to  any  drug,  or  combination  of  drugs. 
The  study  of  the  physiology,  therapy  and  technique  of  ex- 
ternal applications  of  water  (hot,  warm,  lukewarm,  and 
cold  baths;  douches,  sponge-baths,  complete  and  partial 
moist  packs,  s\veat-baths,  etc.,  etc.),  and  likewise  of  the 
internal  uses  of  water  (irrigation  of  stomach  and  intestines, 
drinking  of  water  of  various  temperatures,  etc.,  etc.),  forms 
one  of  the  most  fascinating  subjects  in  medicine.  Inci- 
dentally, let  me  say  that  water  is  not  the  only  carrier  of  tem- 
perature for  clinical  purposes.  The  thermotherapist  fre- 
quently avails  himself  of  air,  in  order  to  apply  heat  or  cold, 
with  gratifying  results.  By  way  of  illustration,  let  me  refer 
to  the  use  of  hot  air  in  cases  of  chronic  rheumatism,  in  fact 


PHILOSOPHY  OF  PHYSIOLOGICAL  THERAPEUTICS.       35 

in  all  cases  in  which  accelerated  oxidation,  or  tissue-meta- 
morphosis, in  the  affected  part  is  desirable.  I  remember  the 
case  of  a  woman  who  had  a  stiff,  painful  knee  for  many 
months,  and  after  taking  medicines  without  limit,  was  cured 
completely  in  one  week  by  the  daily  use  of  the  hot-air  cham- 
ber, into  which  the  limb  was  introduced.  The  physiology  of 
these  applications  is  as  simple  as  it  is  exact. 

Another  important  physiological  method  is  massage  or 
the  manual  or  instrumental  manipulation  of  the  tissues  for 
a  variety  of  purposes.  Its  effects  resemble  those  of  hydro- 
therapy.  It  affects  local  circulation,  and  in  this  way  local 
nutrition,  tissue-change,  absorption  and  excretion.  It  re- 
stores impaired  innervation,  gives  tone  to  the  muscular  coat 
of  the  arteries,  and  promotes  the  activity  of  the  absorbent 
vessels,  relieving  passive  congestion  and  encouraging  the 
absorption  and  excretion  of  morbid  material.  It  supple- 
ments the  action  of  water  most  effectually.  It  would  take 
me  beyond  the  confines  of  my  present  subject  to  discuss  at 
length  the  subject  of  physiological  massage.  I  wish,  how- 
ever, to  correct  the  current  impression  that  the  practice  of 
massage  is  beneath  the  dignity  of  the  physician.  This  im- 
pression is  the  result  of  the  erroneous  notions  entertained  by 
the  profession  in  reference  to  massage.  The  application  of 
massage  as  a  muscular  and  nerve  tonic  in  cases  of  general 
debility  and  neurasthenia  is  only  a  small  part  of  its  field  of 
usefulness.  For  these  purposes  it  is  the  proper  province  of 
the  professional  masseur.  There  are  many  cases,  however,  in 
which  massage  requires  the  tact  us  eruditus  of  the  educated 
physician.  Whenever  it  is  desired  to  cause  the  absorption 
of  inflammatory  products  or  to  break  up  adhesions  or  cica- 
tricial  tissue  by  massage,  the  physician  should  be  the  mas- 
seur. Pelvic  exudates  (Thure  Brandt's  method),  chronic 
inflammatory  swellings  (rheumatic  and  otherwise),  chronic 
synovites,  etc.,  are  of  this  character.  It  is  remarkable  how 
promptly  the  affected  parts  respond  to  treatment.  It  is  not 
generally  known  that  massage  is  an  anodyne  of  great  virtue, 
especially  for  the  relief  of  rheumatic  and  neuralgic  pain.  It 


36  MODERN  PHYSIO-THERAPY. 


regenerates  the  part  by  relieving  passive  congestion,  stimu- 
lating arterial  circulation,  and  thus  produces  a  powerful  al- 
terative effect  upon  the  nutrition  of  the  part.  As  an  anal- 
gesic its  action  is  prompt,  e.  g.  in  cases  of  torticollis,  lum- 
bago, pain  in  any  of  the  accessible  muscles  of  the  body.  In 
such  cases  the  "laying  on  of  hands"  (by  way  of  massage) 
will  at  times  lead  to  miraculous  results.  During  the  treat- 
ment of  a  fracture  or  luxation,  massage  helps  to  reduce 
swelling  and  to  preserve  the  functional  usefulness  of  joints 
and  muscles.  Massage  is  a  valuable  adjunct  to  the  treat- 
ment of  many  surgical3  conditions.  Its  technique  is  as  exact 
as  its  modus  oberandi  is  scientific.  The  same  may  be  said 
of  certain  other  physiological  methods  which  operate  ac- 
cording to  the  same  principles,  c.  g.  the  various  forms  of 
gymnastic  therapeutics,  Swedish  movements,  etc.,  etc. 

A  strictly  biological  concept  of  disease  should  be  the 
basis  of  our  therapeutic  methods.  Let  us  rise  out  of  the 
foggy  recesses  of  exclusive  drug-methods  into  the  pure  at- 
mosphere of  physiological  reasoning.  The  drug-dispenser 
is  never  an  exact  thinker.  He  could  not  be  if  he  would. 
He  many  times  hovers  dangerously  near  the  border-line  of 
quackery.  If  he  is  conscious  of  this  fact  (and  I  dare  say 
most  physicians  are),  his  mind  is  ripe  for  newer  and  bet- 
ter therapeutic  ideas  and  methods.  He  is  ready  and  willing 

8  Incidentally  let  me  say  that  physio-therapy  is  in  principle  and 
practice  the  ally  of  conservative  surgery  or  the  surgery  that  aims  to 
preserve  structure  rather  than  mutilate  or  destroy  it.  The  discovery 
of  anaesthesia,  the  principles  of  surgical  cleanliness,  and  the  Esmarch 
method  of  bloodless  operations,  have  made  invasion  of  the  body  by 
the  knife  comparatively  safe.  This  fact  accounts  for  the  great 
strides  that  have  been  made  in  the  department  of  operative  surgery 
and  the  assiduous  cultivation  of  mechanical  skill  on  the  part  of  the 
operating  surgeons  of  to-day.  Whether  the  operative  surgery  of 
to-day  signifies  actual  scientific  progress  in  medicine  is  more  than 
questionable.  During  the  times  of  Billroth,  Langenbeck,  and  Gross  the 
essence  of  surgical  education  was  the  knowledge  of  when  and  ivhy 
to  operate.  To-day  it  seems  to  be  all-important  to  know  how  to 
operate.  Such  is  the  effect  of  the  example  of  a  mechanical  genius 
like  Lawson  Tait  on  the  many  men  of  much  smaller  caliber  who 
attempt  to  follow  in  his  footsteps.  This  accounts  for  the  present 
age  of  unnecessary  operations.  Clinically  operative  surgery  thrives 


PHILOSOPHY  OF  PHYSIOLOGICAL  THERAPEUTICS.      37 

to  share  in  Nature's  restorative  work,  not  merely  to  go 
through  the  motions  before  his  patients  and  prescribe  some- 
thing— "ut  align  id  fiat."  In  most  cases  it  is  commendable  to 
sit  idly  by  and  let  Nature  do  the  work.  This  is  the  success 
of  homeopathy. 

The  physio-therapeutist  should  be  physiological,  not 
only  in  his  methods,  but  more  especially  in  his  ratiocinations. 
He  must -absorb  the  spirit  of  physiological  therapy,  not 
merely  its  practice.  To  apply  the  methods  without  be- 
ing imbued  with  the  spirit  of  their  rationale  is  an 
injustice  done  to  the  most  glorious  achievement  that 
has  marked  the  history  of  clinical  medicine.  In 
doing  clinical  work  try  to  elaborate  within  your 
minds  the  philosophical  axioms  embodied  in  the  practice 
of  drugless  medication.  After  you  have  made  the  phi- 
losophy of  physiological  therapeutics  a  part  of  your  inner 
consciousness,  you  will  realize  that  you  are  not  merely  add- 
ing a  new  method  or  two  to  your  way  of  practicing  medi- 
cine, but  that  your  work  has  become  the  embodiment  of  a 
new  principle  which,  in  its  last  conclusions  and  applications, 
means  the  disintegration  and  ultimate  destruction  of  faith 
in  the  art  of  medicine  and  aims  at  the  establishment  of 
knoivledge  of  the  science  of  medicine. 


at  the  expense  of  other  lines  of  practice.  That  a  reaction  is  bound 
to  follow  this  era  of  surgical  overwork,  especially  in  gynecology,  is 
plain  to  any  one  who  is  familiar  with  the  history  of  medicine  and 
knows  the  causes  that  led  up  to  the  present  dominating  influence 
of  operative  surgery.  The  development  of  conservative  methods 
along  physiological  lines  will  eventually  force  surgery  into  its  proper 
place  as  the  handmaid  of  medicine.  Abstracting  from  the  glamour 
of  a  modern  surgical  operation  and  the  mechanical  skill  displayed, 
there  is  usually  not  much  of  the  true  scientific  medical  element  in 
it.  Lawson  Tait  and  his  disciples  defer  a  diagnosis  until  after  the 
abdominal  section.  Joints  are  resected  that  might  be  restored, 
amputations  are  made  that  might  be  avoided,  etc.,  etc.,  etc.,  ad  ab- 
surdum.  The  physiological  therapeutist  has  a  well-equipped  arma- 
mentarium to  choose  from  before  he  resorts  to  the  knife.  Mechan- 
ical skill  should  not  be  the  end  and  purpose  of  surgical  education, 
but  always  be  the  means  to  the  end.  This  statement  characterizes 
the  attitude  of  physio-therapy  to  surgery. 


38  MODERN  PHYSIO-THERAPY. 


CHAPTER  II. 
PERSONAL  HYGIENE. 

"I  have  thought  that  some  of  Nature's  journeymen  had 
made  men  and  not  made  them  ^vell,  they  imitated  hu- 
manity so  abominably." — SHAKESPEARE;. 

HYGIENE  (from  the  Greek  hygieia — "health")  is  the 
science  of  preserving-  health  and  preventing  disease.  It  in- 
volves the  knowledge  of  all  the  means  and  agencies  by 
which  the  health  of  the  organism,  wholly  and  in  part,  is 
sustained.  It  deals  with  the  various  potencies  and  activities 
by  which  disease  is  produced. 

Inasmuch  as  hygiene  is  the  science  of  preserving  health, 
ir  is  practically  synonymous  with  applied  physiology,  using 
the  latter  term  in  its  widest  biological  sense.  Physiology 
indicates  the  principles  of  animal  life,  hygiene  suggests  their 
application.  Hygiene,  therefore,  presupposes  the  knowl- 
edge of  physiology. 

The  science  of  preventing  disease  necessarily  depends 
upon  the  various  agencies  and  potencies  by  which  disease 
is  produced.  It  presupposes  the  knowledge  of  heredity, 
etiology  and  pathology,  using  the  latter  term  in  its  widest 
biological  sense.  Thus  hygiene  is  synonymous  with  propliv- 
lactic  medicine. 

An  exhaustive  treatise  on  hygiene  would  practically  be 
a  complete  expose  of  medicine  and  the  collateral  sciences. 
In  a  restricted  sense  we  may  refer  to  hygiene  as  a  thera- 
peutic agent.  As  such  it  represents  an  important  branch  of 
physio-therapeutic  medication.  It  involves  the  forces  that 
affect  the  body  of  man  directly  and  the  immediate  agencies 


PERSONAL  HYGIENE.  39 

which  commonly  are  concerned  in  the  production  of  the 
various  ills  to  which  his  organism  is  liable  to  fall  a  victim 
(personal  hygiene). 

The  physical  condition  of  man  to-day  represents  a  more 
or  less  well-marked  deviation  from  the  natural  standard. 
His  occupation,  his  manner  of  living,  his  diet,  his  environ- 
ments, his  habits,  are  all  calculated  to  impair  his  vitality  and 
to  cause  partial  or  general  deterioration  and  collapse.  The 
demands  of  Nature  are  constant  and  fixed.  Health  depends 
upon  certain  conditions.  In  proportion  as  man  complies 
with  Nature's  demands  he  will  enjoy  a  corresponding  de- 
gree of  health.  Let  man  deny  nature's  demands  in  toto  or 
in  parte  and  a  proportionate  amount  of  normal  well-being 
will  be  denied  to  him.  Disease  does  not  put  in  a  hap- 
hazard appearance.  It  follows  like  a  logical  sequence  to 
the  premises  furnished  by  man.  I  have  stated  on  another 
occasion,  and  beg  to  repeat  and  emphasize  it,  that  the  nor- 
mal man  as  intended  by  nature  is  not  the  average  man  as 
produced  by  twentieth-century  civilization.  There  are  a 
thousand  illustrations  which  might  be  adduced  in  explana- 
tion and  corroboration  of  this  statement.  Thus,  the  modern 
city  is  like  an  immense  prison  wherein  individuals  and  fam- 
ilies vegetate,  deteriorate  and  finally  succumb.  In  spite  of 
all  our  vaunted  progress  it  can  not  be  denied  that  man  has 
improved  only  in  accidentals,  but  is  becoming  more  and 
more  woefully  deficient  in  essentials. 

In  treating  the  sick  human  body  the  physician's  concepts 
of  hygiene  should  resolve  themselves  into  a  continued  effort 
to  restore  natural  conditions  and  environments  and  to  en- 
courage man  to  return  to  the  natural  standard.  Let  the 
physician  beware  lest  he  forget  the  fundamental  laws  of 
health  while  he  is  busily  engaged  in  remembering  and  pre- 
scribing the  latest  remedy  for  the  relief  of  some  conspicu- 
ous symptom.  We  live  in  an  age  of  contradictions  and  ab- 
surdities. The  ubiquitous  medicine-bottle  looms  up  like  a 
specter  of  long-forgotten  days,  while  anatomy,  physiology, 
hygiene,  dietetics  and  other  branches  of  purest  medical 


40  MODERN  PHYSIO-THERAPY. 

science  can  only  be  found  on  the  shelves  of  medical  libraries, 
carefully  secured  behind  lock  and  key  lest  they  escape. 

In  presenting  hygiene  as  a  therapeutic  measure  in  a 
practical  form,  we  can  summarize  hygienic  philosophy  in 
the  old  and  trite  but  eternally  true  saying  of  the  father  of 
medicine:  "A  man  with  active  emunctories  (skin,  lungs, 
kidneys  and  bowels)  can  not  be  sick!"  Apply  this  state- 
ment logically  and  consistently  to  its  very  last  consequences 
and  you  will  establish  a  system  of  personal  hygiene  as  per- 
fect and  modern  as  any  man  could  to-day.  The  function  of 
the  four  emunctories  should,  therefore,  receive  the  first  and 
constant  attention  of  the  physician  in  the  treatment  of  dis- 
ease. 

Before  proceeding  to  consider  these  and  other  special 
aspects  of  therapeutic  hygiene,  let  me  interpose  a  short 
reference  to  a  feature  of  our  subject  which  is  not  directly 
connected  with  the  clinical  purposes  which  we,  in  the  en- 
forcement of  hygienic  rules  of  action,  may  have  in  view, 
but  which  is  nevertheless  closely  interwoven  with  the  physi- 
cian's work  and  its  ultimate  objects.  Men  and  more  espe- 
cially women  sacrifice  many  a  hygienic  principle  to  a  per- 
verted sense  of  the  beautiful.  A  truly  aesthetic  apprecia- 
tion of  the  glorious  masterwork  of  construction  which  the 
human  body  in  its  perfect  lines  and  proportions  represents, 
is  a  species  of  education  of  untold  hygienic  value.  A  sick, 
sickly  or  sickly-looking  body  is  not  beautiful.  Man  can  not 
improve  upon  the  splendid  beauty  of  form  and  proportion 
which  an  all-wise  Providence  designed.  An  appearance  of 
beauty  must  convey  a  suggestion  of  health  and  hygienic 
perfection.  An  attempt  to  mutilate  or  deform  the  human 
body  is  an  aesthetic  crime  and  a  hygienic  outrage.  To  im- 
pair the  physical  perfection  of  the  body  and  to  undermine 
its  health  in  order  to  satisfy  notions  and  fancies  of  a  per- 
verted or  morbid  character  are  insults  offered  to  what  Lud- 
wig  Buechner  calls  the  godlike  dignity  of  the  human  frame. 
Think  of  the  ear-rings  which  are  worn  in  imitation  of  the 
habits  and  customs  of  savages.  Think  of  the  modern  high- 


PERSONAL  HYGIENE.  41 

heel  shoe  with  its  necessarily  disastrous  results  on  the  poise 
of  the  whole  superstructure  and  the  perversion  of  the  pur- 
pose which  nature  had  in  view  in  planning  the  human  body 
and  its  finely  adjusted  bony  frame.  Think  of  that  typical 
example  of  concentrated  ugliness,  the  narrow  waist,  and 
that  most  cruel  of  modern  instruments  of  torture,  the  tight 
corset,  the  disease-producer  par  excellence.  Amid  the  men 
who,  by  virtue  of  their  profession  or  their  office,  are  to 
take  care  of  the  health  of  the  people,  there  is  not  one  who 
does  not  fully  realize  and  understand  the  position  of  the 
tight  corset  as  a  pathogenic  factor  with  a  most  sorrowful 
record.  Why  are  disease-producers  like  this  not  fought 
like  the  tubercle-bacillus,  etc.?  Indifference  in  this  respect 
and  frantic  sanitary  activity  in  other  directions, — what  a 
satire  on  human  intelligence  and  modern  civilization !  Na- 
ture is  all  beautiful,  and  true  culture  never  offends  against 
the  intentions  of  Nature.  Modern  man  and  modern  woman 
constantly  do.  The  Indian  who  paints  his  forehead,  cheeks 
and  chin  with  gaudy  colors,  and  decorates  his  head  with 
leathers,  beads  and  other  ridiculous  trinkets,  while  the  scalp 
of  a  vanquished  foe  dangles  from  his  belt,  seems  to  be 
the  prototype  of  the  modern  woman  with  powder  and  paint, 
with  feathers  and  plumes,  that  speak  many  a  mute  but  elo- 
quent necrologue  on  behalf  of  the  gay  songbird  whose  tune- 
ful lays  were  hushed  when  the  singer  was  sacrificed  in  the 
interest  of  a  woman's  headgear.  Try  to  behold  before  your 
mind's  eye  the  classic  type  of  feminine  beauty,  the  Milesian 
Venus,  clad  in  a  waist-constricting  corset.  Fancy  her  go- 
ing through  equilibristic  performances  on  high-heel  shoes, 
crowned  with  what  looks  like  a  hybrid  between  a  botanical 
collection  and  an  ornithological  museum,  while  the  thousand 
fragrant  odors  that  emanate  from  her  suggest  the  incense 
that  the  lord  of  creation  offers  up  to  his  gaudily  attired  and 
gaily  decorated  mate.  Surely  the  modern  female  biped 
must  be  a  mental  imbecile.  This  is  the  only  plausible  expla- 
nation of  and  apology  for  the  insults  to  her  physical  perfec- 
tion to  which  she  constantly  submits.  In  fulfilling  your  mis- 


42  MODERN    I'm  sio- 


sion  as  physicians,  remember  that  you,  as  Hyrtl  says,  are  to 
be  apostles  of  true  culture  (hygiene  of  the  mind).  You  are  to 
be  missionaries  of  that  eternal  religion  which  is  preached  in 
eloquent  language  by  the  myriads  of  stars  above,  by  the 
merry  songsters  of  the  woodland,  by  the  flowers  that  scent 
the  shady  banks  of  the  brook  and  the  sun-kissed  brow  of 
the  distant  hills.  Teach  your  patients  to  have  respect  for 
the  human  body.  Make  them  understand  that  normal  form 
and  natural  function  are  the  prime  conditions  of  health  and, 
therefore,  of  beauty.  Having  done  so,  you  can  begin  to 
teach  them  the  principles  of  personal  hygiene. 

In  applying  the  Hippocratic  admonition  concerning  the 
four  emunctories  let  us  briefly  consider  the  hygienic  im- 
portance of  the  skin,  the  lungs,  the  kidneys  and  the  bowels. 

FUNCTIONS  OP  THE  SKIN.  —  Physiologists  tell  us  that  the 
skin  is  an  organ  of  excretion  as  well  as  of  respiration.  A 
man  in  good  health  loses  by  the  skin  in  twenty-four  hours 
approximately  1-25  of  his  body-weight.  The  skin  resembles 
the  lungs  in  its  function,  in  that  it  takes  up  oxygen  and  ex- 
cretes carbonic  acid.  The  skin  is  the  great  thermic  regu- 
lator of  the  body.  Therein  lies  its  clinical  importance.  It  is 
the  protective  covering  of  the  body,  at  once  shielding  the 
latter  and  communicating  outside  impressions  to  the  various 
parts  of  the  body. 

\Yhat  animal-heat  means  to  the  organism  will  be  seen 
later  on  under  the  head  of  Hydro-therapy.  The  very  life  of 
the  organism  is  bound  up  in  the  process  of  oxidation.  Ra- 
diation of  heat-units  constantly  takes  place  through  the  skin 
in  the  form  of  gases,  vapors  or  even  liquids.  Through  the 
skin  we  can  influence  the  fever  process,  the  metabolic 
changes  in  the  organism  and  thus  the  very  life  of  the  latter. 
It  is  plain,  therefore,  that  the  skin  should  receive  a  large 
share  of  clinical  attention.  It  not  infrequently  is  the 
barometer  by  which  conditions  within  are  indicated.  It 
serves  as  a  sort  of  dumping-ground  for  the  inactive  sewers 
of  the  body,  and  becomes  the  seat  of  various  forms  of  mor- 
bid conditions  that  are  secondarv  to  functional  disturbances 


PERSONAL  HYC.IENE.  43 

in  the  organism.  Non-parasitic  skin-diseases  are  never 
primary  or  local  affections.  They  are  evidences  of  trouble 
somewhere  in  the  machinery  of  the  body  and  should  be 
looked  upon  as  symptoms  and  not  as  diseases  per  se.  (See 
SKIN-DISEASES.) 

It  is  easy  to  understand  why  the  face  is  more  frequently 
the  seat  of  skin-disease  than  any  other  part  of  the  body- 
surface.  It  is  exposed  to  light  and  air  more  and,  therefore, 
is  functionally  more  active  than  any  other  portion.  The 
skin  of  the  face  is  doing  compensatory  work  and  is,  there- 
fore, the  seat  of  continuous  congestion.  Hence  the  fre- 
quency of  facial  skin-troubles.  Exposure  of  the  body  at 
large  is  the  beginning  of  logical  treatment. 

The  care  of  the  skin  depends  on  three  factors  of  cardinal 
importance,  to  wit :  cleanliness,  air  and  light.  Before  cloth- 
ing was  invented,  the  skin  was  well-nigh  able  to  take  care 
of  itself.  The  skin  being  exposed  to  air  and  light  was  kept 
hvgienically  clean.  Excretion  was  unhindered.  The  dew 
of  the  morning,  an  occasional  rainfall  or  a  bath  in  the  in- 
viting waters  of  a  crystal-clear  brook  removed  the  deposit 
of  dirt  from  the  skin  of  primeval  man.  Fresh  air  and  light 
kept  the  skin  functionally  active  and  the  organism  at  large 
free  from  slack.  This  was  in  the  happy  days  when  even  fig- 
leaves  were  a  luxury  and  when  man  in  all  his  pristine  per- 
fection traversed  the  fields  and  meadows  pure  at  heart  and 
beautiful  like  all  of  Nature's  works.  Naturalia  non  sunt 
turpia!  Eternal  vigilance  and  constant  physical  strife  kept 
him  in  prime  condition.  Disease  was  unknown  beyond  the 
injuries  that  were  incidental  to  his  mode  of  living. 

Compare  these  splendid  physiological  conditions  with  the 
innumerable  hygienic  sins  which  the  average  man  of  to- 
day, who  is  the  prisoner  and  victim  of  unhygienic  environ- 
ments and  health-impairing  influences,  commits.  The  skin 
of  the  average  man  in  the  large  towns  who  is  poor  and 
vegetates  in  the  dust-laden  atmosphere  of  a  factory  and  in 
the  ill-ventilated  and  badly  lighted  prison-cells  of  a  tene- 
ment-house, is  necessarily  covered  with  a  slimy  and  mal- 


44  MODERN  PHYSIO-THERAPY. 

odorous  mixture  of  sweat,  sebaceous  material  and  oil  from 
the  cuticle.  There  is  no  sunlight,  no  fresh  air  to  cleanse  and 
disinfect  his  skin.  Eventually  the  functional  activity  of  the 
skin  is  impaired  and  favorable  conditions  are  created  for 
the  development  of  the  thousand  and  one  forms  of  auto- 
intoxication. Thus  the  vitality  of  the  body  is  lowered  and 
the  soil  rendered  fertile  for  the  reception  and  development 
of  microscopic  scavengers.  The  resisting  power  of  the  or- 
ganism sinks  below  par.  Thus  liability  to  sickness  and  pre- 
mature death  are  the  inevitable  result. 

The  beneficent  hygienic  effects  of  air  and  light  on  the 
skin,  and  thus  on  the  whole  organism,  can  not  be  overesti- 
mated. In  all  diseases  of  metabolism,  the  sun-bath  should 
be  given  a  foremost  therapeutic  place.  The  skin  in  all 
febrile  conditions  and  all  wasting  diseases  requires  light  and 
air,  for  obvious  reasons.  In  all  chronic  diseases  the  patient's 
skin  should  receive  the  benefit  of  the  alterant  action  of  light 
and  air.  This  and  the  use  of  water  should  be  insisted  upon 
as  a  matter  of  routine.  Light  and  air  are  never  contra- 
indicated.  Remember  this  more  especially  in  connection 
with  that  most  neglected  portion  of  our  anatomy,  the  feet. 
Exposure  to  light  and  air  is  a  prophylactic  of  prime  im- 
portance and  a  therapeutic  agent  of  marvelous  power. 

It  would  carry  me  too  far  to  fully  discuss  the  hygienic 
aspect  of  clothing.  The  object  of  clothing  should  be  to 
cover  those  parts  of  the  body  which  conventional  notions 
teach  us  to  cover,  and  to  protect  the  body  against  cold.  It 
should  not  interfere  with  the  function  of  the  skin.  This  re- 
fers more  especially  to  underwear  which  should  be  loose  and 
of  wide  texture.  Woolen  underwear  is  nearly  always  ob- 
jectionable. The  outer  garment  should  be  of  denser  texture 
in  order  to  protect  the  body  against  atmospheric  moisture. 
Tightly  fitting  clothing  is  never  proper.  Loose  garments 
do  not  interfere  with  evaporation.  The  air  should  circulate 
freely  between  the  skin  and  the  clothing  and  between  the 
different  layers  of  the  latter  for  purposes  of  ventilation.  In 
addition  to  this  it  must  be  remembered  that  this  volume  of 


PERSONAL  HYGIENE.  45 

air  in  itself  plays  the  part  of  an  article  of  clothing  because 
it  prevents  the  too  rapid  radiation  of  heat.  Underwear 
should  absorb  moisture,  the  outer  garment  should  not ;  both, 
however,  should  be  poor  conductors  of  heat,  but  should  not 
be  air-tight.  In  a  general  way,  it  must  be  admitted  that 
the  tendency  is  towards  too  much  clothing.  Perversions  of 
taste  and  sense,  as  displayed  in  the  garments  especially  of 
women,  are  prolific  sources  of  bodily  ills.  A  book  might  be 
written  on  the  diseases  and  diseased  conditions  produced  by 
high-heel  shoes  and  tight  corsets. 

The  care  of  the  skin  involves  strict  enforcement  of  clean- 
liness through  the  consistent  and  liberal  use  of  soap  and 
water.  This  should  be  the  beginning  of  the  hygienic  regime 
in  all  chronic  disturbances  of  nutrition  and  metabolism. 
Soap  and  water  are  never  contra-indicated  unless  the  skin 
itself  is  the  seat  of  disease  and  forbids  violent  manipulation. 
Discourage  the  habitual  use  of  warm  or  hot  water.  Cold 
water  is  the  skin-regulator  par  excellence,  unless  there  are 
special  indications  against  its  use,  e.  g.  in  cases  of  chronic 
nephritis  and  whenever  skin-reaction,  owing  to  loss  of  vas- 
cular tone,  is  absent  or  deficient. 

FUNCTIONS  OF  THE  LUNGS. — The  stomach  is  sometimes 
referred  to  as  the  furnace  which  receives  the  fuel,  and  by 
burning  it  up  keeps  the  fire  of  life  from  going  out.  In  real- 
ity this  simile  does  not  hold  good.  The  stomach  prepares 
the  fuel  for  the  burning-up  process.  The  latter  takes  place 
in  the  lungs.  The  lungs  take  up  the  oxygen  from  the  air. 
Over  a  space  of  from  eighteen  to  twenty-two  square  feet 
(for  such  is  the  extent  of  the  breathing  surface  in  the 
chest)  oxygen  is  absorbed  by  the  blood,  is  carried  by  the 
coloring  matter  of  the  red  blood-cells  to  all  parts  of  the  or- 
ganism and  acts  upon  the  combustible  constituents  of  the 
body.  The  principal  waste  left  from  this  burning-up  proc- 
ess (oxidation)  is  carbonic  acid,  which  is  excreted  by  the 
lungs  and  discharged  with  the  exhaled  air.  Complete  ex- 
halation never  takes  place.  Even  after  forced  expiration 
there  still  remains  a  volume  of  residual  air  in  the  chest 


46  MODERN  PHVSIO-TIIKRAPY. 

(about one  hundred  cubic  inches).  About  twenty  cubic  inches 
of  air  are  taken  in  and  given  off  during  each  act  of  normal 
respiration.  Physiological  oxidation  requires  a  correspond- 
ing amount  of  oxygen.  Thus  we  see  that  metabolism  or  the 
constant  regeneration  of  tissue  depends  on  normal  lung- 
function.  The  clinical  significance  of  this  statement  be- 
comes apparent  when  we  consider  that  in  most  chronic  dis- 
eases we  are  dealing  with  disorders  of  metabolism. 

Oxygen  is  the  life-element  par  excellence.  The  first 
principle  of  hygienic  medication,  therefore,  is  to  supply  the 
organism  with  oxygen  (fresh  air)  and  to  preserve  the 
oxygen-receiving  and  oxygen-carrying  power  of  the  body. 
Sunlight  has  a  marked  affinity  for  oxygen.  Therefore,  fresh 
air  and  sunlight  represent  an  inseparable  duality.  The  per- 
fection of  the  mechanical  act  of  respiration  is  necessary  for 
the  proper  reception  of  oxygen.  From  a  clinical  point  of 
view,  therefore,  the  hygiene  of  lung-function  consists  in 
giving  the  body  fresh  air  and  sunlight  and  in  training  the 
individual  to  practice  the  mechanism  of  respiration  in  as 
perfect  a  manner  as  possible. 

In  proportion  to  the  physiological  perfection  of  oxida- 
tion, the  body  will  possess  the  power  of  resisting  the  de- 
teriorating effects  of  disease-producers.  The  less  oxygen  is 
actually  utilized  and  consumed,  the  less  resisting  power  the 
body  possesses.  The  oxygen-consumption  of  the  organism 
determines  its  degree  of  vitality.  Both  are  in  direct  propor- 
tion to  each  other.  This  is  a  hygienic  and  therapeutic  prin- 
ciple of  overtowering  significance.  Disease-producing 
germs  can  not  gain  a  foothold  and  will  not  grow  and  thrive, 
unless  the  vitality  of  the  organism  is  low  enough  to  make 
the  latter  a  favorable  soil  for  germ-culture.  Micro-organ- 
isms are  ubiquitous.  Every  one  of  us  is  exposed  to  the 
same  danger  of  infection.  Some  are  infected,  others  are 
not.  Some  recover,  some  succumb.  The  pathogenic  germs 
are  present  everywhere  and  invade  the  organism  of  every 
one  within  reach  of  infection.  The  tubercle-bacilli  are  in- 
digenous in  every  community.  Every  one  of  us,  at  some 


PERSONAL  HYGIENE.  47 

time  or  another,  inhales  these  germs.  Yet  only  a  certain 
number  of  individuals  are  infected  and  contract  bacillary 
phthisis,  \\~hy  do  others  escape?  A  better  opportunity 
will  never  offer  itself  for  the  discussion  of  the  peculiar 
changes  which  the  study  of  microscopic  life  has  wrought  in 
our  clinical  reasoning.  The  undue  prominence  of  bac- 
teriology (biology  of  germs)  has  detracted  from  the  atten- 
tion to  which  physiology  (biology  of  the  animal  body)  is 
entitled.  The  former  has  only  a  secondary  importance  as 
compared  to  the  latter,  which  by  its  very  nature  must  come 
first  in  theory  and  practice. 

Bacteria,  like  all  plants,  require  a  soil  to  furnish  the 
necessary  conditions  favorable  to  their  development.  With- 
out a  suitable  soil  or  culture-medium  germs  can  not  grow. 
It  is  evident,  therefore,  that  the  preparation  of  the  soil  is 
the  life-condition  of  the  germ  and  its  growth.  The  crusade 
against  tuberculosis  should  not  primarily  be  a  warfare 
against  the  bacillus.  The  latter  can  be  left  out  of  consid- 
eration because  its  life  and  growth  are  secondary  to  the 
condition  of  the  tissues  of  the  human  organism.  These  are 
the  soil.  Render  the  soil  sterile  and  tuberculosis  will,  after 
another  generation  or  two,  be  stamped  out  of  existence. 
Teach  the  individual  and  the  community  the  first  principles 
of  hygiene  in  connection  with  their  mode  of  living ;  compel 
them,  if  need  be,  by  main  force  to  practice  hygiene  in  tak- 
ing care  of  their  bodies,  and  the  tuberculosis-problem  will 
solve  itself.  This  dire  and  murderous  affliction  is  the  logical 
punishment  which  nature  metes  out  to  those  who  sin  against 
fundamental  hygienic  principles.  The  offender  may  be  an 
individual,  a  family,  a  tribe,  a  race.  In  the  struggle  for  ex- 
istence the  fittest,  i.  e.  the  most  viable,  is  bound  to  survive. 
Appease  outraged  Nature  and  the  ban  is  lifted.  If  the 
hygienic  quality,  i.  c.  the  resisting  power  of  the  body,  is 
kept  at  a  certain  level,  the  tubercle-bacillus  is  not  any  more 
to  be  feared  than  the  numberless  forms  of  microscopic  plant- 
life  that  inhabit  Nature's  vast  domain.  The  term  "scav- 
enger" is  distinctly  relative  in  its  meaning.  In  discussing 


48  MODERN  PHYSIO-THERAPY. 

the  philosophy  of  physiological  therapeutics  I  had  occasion 
to  refer  to  that  ever-present  and  ever-active  tendency  of 
Nature  toward  a  standard  of  perfection  characteristic  of 
every  species.  The  activity  of  the  scavenger  is  ihe  outward 
expression  of  Nature's  desire  to  destroy  what  falls  beneath 
this  standard  of  specific  perfection.  Nature  invariably  sac- 
rifices the  individual  to  the  species,  the  part  to  the  whole, 
in  this  sense  the  activity  of  the  scavenger  is  constructive  to 
the  species  while  it  may  be  obstructive  to  the  individual. 
The  scavenger  is  a  pathogenic  element  in  this  provisional 
sense.  The  treatment  of  a  tubercular  subject  is  a  problem 
of  sanitation  with  a  wide  economic  meaning.  It  really  in- 
volves a  triple  task,  to  wit:  i.  To  protect  the  integrity  of 
the  species  (prevention  of  marriages  between  consumptives 
or,  for  that  matter,  all  individuals  whose  physical  standard 
is  below  that  of  the  species)  ;  2.  To  remove  hotbeds  of 
scavenger-breeding  from  our  midst  (by  isolating  all  con- 
sumptives) and  3.  By  giving  each  consumptive  patient  the 
benefit  of  a  rational  therapeutic  regime. 

To  be  able  to  cope  with  great  problems  of  sanitation  and 
hygienic  therapy,  such  as  indicated,  a  thoroughly  conscious 
appreciation  of  the  physiological  meaning  of  lung-function 
is  necessary.  The  lungs  of  the  average  person  offer  a  sur- 
face of  approximately  twenty  square  feet  to  the  oxygen- 
laden  air.  The  process  of  physiological  combustion  ("life") 
depends  on  the  supply  of  oxygen  and  its  proper  usage  in  the 
system.  There  are  four  important  lessons  in  therapeutic 
hygiene  contained  in  this  statement :  Fresh  air  to  furnish 
oxygen;  light  to  aid  in  the  assimilation  of  oxygen;  gym- 
nastics of  the  thorax  to  preserve  the  mechanism  of  respira- 
tion in  a  state  of  relative  perfection ;  muscular  exercise  of 
the  ivhole  body  to  preserve  the  physiological  equilibrium  in 
the  exchange  of  gases.  In  all  chronic  diseases,  especially  of 
the  blood  and  the  respiratory  organs,  this  fourfold  aspect  of 
lung-function  should  be  the  beginning  and  the  basis  of  our 
therapeutic  reasoning. 

FUNCTIONS  OF  THS  BOWELS  AND  KIDNEYS. — The  com- 


PERSONAL  HYGIENE.  49 

Uistible  material  which  is  acted  upon  by  the  oxygen  in  the 
body  and  slowly  consumed,  enters  the  body  mainly  through 
the  stomach  in  the  form  of  food.  We  can  easily  under- 
stand the  physiological  wisdom  in  the  Hippocratic  dictum 
concerning  the  four  emunctories.  Slow  oxidation  means 
life.  In  the  process  of  physiological  oxidation  the  four 
emunctories  play  the  most  essential  part,  and,  therefore, 
they  are  the  true  pillars  of  life. 

The  functions  of  the  bowels  and  kidneys  are  properly 
discussed  under  the  head  of  alimentary  hygiene  or  dietetics. 
The  latter  deals  with  the  quantity,  quality  and  preparation 
of  food,  with  the  physiological  purposes  of  food,  and  with 
the  therapeutic  application  of  the  principles  involved.  While 
it  is  properly  a  part  of  personal  hygiene,  it  covers  an  im- 
mense field  and  comes  home  to  the  individual  patient  more 
than  any  other  part  of  hygiene.  I  have,  therefore,  thought 
it  wise  to  consider  dietetics  separately. 

I  can  not  refrain,  however,  from  calling  attention  to  a 
few  characteristic  points  in  connection  with  alimentary 
hygiene.  Bad  habits  are  not  infrequently  the  cause  of  dis- 
ease. The  constipated  hypochondriac  is  probably  the  only 
person  who  has  the  true  heartfelt  appreciation  of  the  privi- 
lege, the  luxury  and  the  happy  possibilities  of  a  good  evacua- 
tion. The  latter  is  a  boon  to  be  thankful  for  and  an  accom- 
plishment to  be  proud  of.  Frederick  the  Great,  who  was  as 
much  of  a  philosopher  as  he  was  a  strategist,  was  discuss- 
ing the  wants  of  the  common  soldier  on  the  field  of  battle. 
A  field-chaplain  suggested  that  the  soldiers  before  a  battle 
should  be  taught  to  pray.  Frederick  opined  that  soldiers 
who  fall  on  the  field  of  battle  have  done  their  full  duty  and 
would,  therefore,  go  straight  to  heaven.  Those  who  sur- 
vive have  plenty  of  time  to  pray  after  the  battle.  The  chap- 
lain thought  that  soldiers  ought  to  be  prepared  in  some  man- 
ner or  other.  Frederick  said :  "Fill  their  powder-bags 
and  empty  their  bowels  ;  all  else  is  of  no  consequence." 

People  should  be  taught  to  have  some  respect  for  the 
calls  of  nature  and  extend  this  respect  to  others  who  might 


50  MODERN  PHYSIO-THERAPY. 

be  called.  Catherine  of  Russia  subordinated  even  diplo- 
matic functions  of  state  to  the  peristaltic  function  of  her 
large  intestines.  No  assemblage  of  princes  and  diplomats, 
however  distinguished  and  brilliant,  superseded  in  her  mind 
the  importance  of  alimentary  excretion.  On  one  occasion 
o  gorgeous  delegation  cf  Oriental  potentates  had  to  wait 
over  thirty  minutes  while  Her  Imperial  Majesty  occupied 
the  throne  where  no  one  else  could  have  taken  her  place.  To- 
day— with  more  definite  knowledge  of  hygiene — people  are 
afraid  to  do  the  bidding  of  nature  for  fear  of  giving  offense 
or  because  they  are  denied  the  chance.  They  invite  the 
legion  of  troubles  and  complaints1  which  follow  the  disre- 
gard for  the  demands  of  health.  Children  in  school,  women 
m  the  midst  of  social  obligations,  men  in  business  suppress 
and  ignore  what  ought  to  be  a  welcome  invitation.  Thus  a 
race  of  constipated  malcontents  is  being  bred  in  an  age  of 
alleged  enlightenment.  In  some  of  our  large  cities  where 
health-officials  arrest  a  man  who  is  supposed  to  aid  in  the 
propagation  of  tuberculosis  by  expectorating  on  the  side- 
walk, there  are  no  public  commodities  for  the  relief  of 
urgent  necessities.  Thus  the  spread  of  disease  is  encour- 
aged among  the  human  species,  while  horses,  cows  and  dogs 
are  well  and  happy  in  the  enjoyment  of  the  unconditional 
privilege  of  depositing  their  alimentary  excreta  unhindered 
on  the  public  highway.  O  temporal  O  mores! 

The  hygiene  of  the  alimentary  canal  requires  a  sound  and 
healthy  condition  of  its  several  parts.     The  mouth  should 


'Auto-intoxication  from  the  residual  matter  in  the  large  intes- 
tines is  by  many  considered  the  most  prolific  cause  of  disease  and  of 
the  many  phases  of  decay  and  retrograde  metamorphosis  included 
under  the  head  of  senility  (BOUCHARD,  METSCHNIOFF).  There 
seems  to  be  no  doubt  that  man  would  be  better  off  without  his  large 
intestines.  After  many  ages  of  evolution  man  will  no  doubt  be  freed 
from  the  encumbrance  of  an  appendage  which  is  not  only  unneces- 
sary, but  a  constant  source  of  infection,  disease,  and  decay.  The 
future  man,  under  these  improved  conditions,  will  be  in  his  prime 
when  he  reaches  the  biblical  allowance  of  threescore  and  ten. 
Metschnikoff  thinks  that  health  (life)  depends  upon  the  degree 


PERSONAL  HYGIENE.  51 

receive  its  share  of  attention.  It  should  be  washed  out,  es- 
pecially in  the  morning.  The  teeth  should  be  fit  for  their 
work  of  thorough  and  sloi^>  mastication.  In  this  age  of 
superior  dental  surgery  there  is  no  excuse  for  poor  teeth. 
They  are  not  infrequently  the  cause  of  disease.  Other 
points  in  connection  with  the  subject  of  alimentary  hygiene 
I  will  have  occasion  to  discuss  under  the  special  head  of 
Dietetics. 

The  hygienic  importance  of  water  is  not  appreciated  as 
it  should  be.  It  is  nature's  beverage  and  can  never  be  sup- 
planted by  artificial  substitutes  like  beer,  wine,  coffee,  tea, 
soda-water,  etc.  Father  Kneipp,  who  was  not  a  scientist, 
but  made  up  for  the  lack  of  scientific  training  by  a  liberal 
supply  of  common  sense,  discountenanced  the  use  of  arti- 
ficial beverages  as  substitutes  for  water.  In  his  character- 
istic picturesque  language  he  appeals  to  his  fellow-men  to 
return  to  the  simplicity  and  frugality  of  former,  physically 
stronger  generations,  and  refers  thus  to  water:  "You  that 
are  sickly  and  weak,  nervous  and  irritable,  that  distend  your 
stomachs  with  thin  beer  and  strong  coffee;  you  that  reek 
with  the  dirt  and  filth  of  ill  health, — go  and  take  from  the 
hand  of  Nature  the  goblet  of  life  filled  with  the  pure,  cold, 
crystalline  blood  of  the  meadows  and  mountains !"  People 
do  not,  as  a  rule,  drink  enough  pure  water.  The  bulk  of  it 
should  be  drunk  between  meals,  not  during  meals.  Like  a 
cadaverous  voice  from  a  musty  grave  comes  the  admonition 
of  the  modern  health-officer  to  boil  your  drinking-water. 


of  phagocytic  power  possessed  by  the  corpuscular  elements  of  the 
blood.  He  believes  that  the  human  body  is  the  battling  ground  and 
that  a  continued  contest  takes  place  between  the  normal  cell-ele- 
ments of  the  blood  and  the  microscopic  intruders  from  without. 
The  problem  of  sustaining  life  (health)  consists  in  preserving  the 
fighting  quality  of  the  red  corpuscles.  This  quality  is  contained  in 
the  hemoglobin,  the  oxygen-carrier.  Gaseous  combustion-products 
in  the  blood  disintegrate  the  hemoglobin.  Since  the  large  bowel  is 
always  filled  with  these  waste-derivatives,  and  since  absorption  from 
the  large  bowel  constantly  takes  place,  we  are  prepared  to  understand 
the  pathogenic  importance  of  auto-intoxication. 


52  MODERN  PHYSIO-THERAPY. 

Pettenkofer,  of  Munich,  declared  that  he  would  rather  eat 
live  germs  than  dead  ones,  that  he  would  rather  make  an 
aquarium  than  a  cemetery  out  of  his  stomach.  Boiled  water 
is  stale  water  and  can  never  take  the  place  of  fresh  water. 
If  water  is  infected,  it  should  be  filtered,  aerated  and  ex- 
posed to  light.  Geisler's  experiments  show  that  typhoid 
bacilli  die,  if  the  water  containing  them  is  aerated  and  ex- 
posed to  sunlight.  Oxygen  and  actinic  rays  of  light  are  na- 
ture's own  disinfectants.  Water,  after  aeration  and  trans- 
lumination,  can  be  cooled  and  served.  The  proper  manage- 
ment of  the  water-supply  in  large  cities  is  an  economic  and 
hygienic  problem  of  stupendous  importance.  It  involves  the 
health  of  thousands  of  people.  It  is  a  problem  which  should 
be  solved  by  men  who  have  brains  and  hearts,  and  inde- 
pendently of  politicians  and  rotten  municipal  governments. 
"The  health  of  the  people,"  says  Lord  Beaconsfield,  "is  the 
lirst  duty  of  the  statesman."  Again  we  arrive  at  the  same 
hygienic  principle  which  teaches  us  that  bacteria  are  not 
pathogenic  unless  the  soil  is  favorable  to  their  development. 
A  healthy  human  body  is  proof  against  these  microscopic 
scavengers.  All  these  problems  can  be  solved  by  making 
physiology  and  hygiene  a  part  of  the  practical  education  of 
the  people.  Little  Japan  might  in  this  respect  serve  as  a 
shining  example  for  the  white  races  of  the  East  and  West 
that  have  had  a  monopoly  on  civilization. 

The  liberal  use  of  good  drinking  water  is  probably  the 
best  tonic  that  the  physician  can  recommend.  It  keeps  the 
kidneys  active,  prevents  passive  congestions  and  dilutes  the 
renal  excretion.  There  is  hardly  a  condition  in  which  water 
as  a  beverage  is  not  indicated.  Further  reference  to  this 
important  subject  will  be  made  under  the  head  of  Dietetics. 

It  would  be  foreign  to  the  purposes  of  our  discussion 
to  enter  into  the  details  of  a  subject  of  such  proportions  as 
hygiene.  The  question  of  sex,  age,  race,  heredity,  conta- 
gion, infection,  environment,  occupation,  habit,  etc.,  offer  a 
vast  field  for  research  and  speculation.  The  many  aspects 


PERSONAL  HYGIENE.  53 

of  domestic  and  civic  hygiene  are  of  absorbing  interest  and 
vital  significance.  I  wish  to  restrict  myself  to  what  might 
be  designated  as  therapeutic  hygiene  or  hygiene  as  a  thera- 
peutic agent  in  the  treatment  of  disease.  I  wish  to  em- 
phasize the  essentials  of  hygienic  treatment  in  as  far  as 
they  concern  the  physician  in  his  clinical  work.  In  the 
treatment  of  chronic  diseases  the  tide  is  not  infrequently 
turned  in  the  patient's  favor  by  the  correction  of  a  viola- 
tion of  some  hygienic  principle.  Many  a  patient  goes  from 
one  physician  to  another  without  receiving  any  benefit  until 
some  simple  phase  of  his  case  is  discovered  that  clears  up 
the  situation.  It  is  notoriously  a  fact  that  the  elementary 
truths  of  medical  science,  the  simplest  laws  of  health,  are  not 
infrequently  disregarded  by  the  physician  who  takes  too 
much  for  granted  in  investigating  his  patient's  case 
or  who  tries  to  find  something  unusual  which  his 
predecessors  have  failed  to  discover.  Five  good 
clinicians  in  succession  examined  and  treated  a  case 
of  epilepsy  in  a  young  woman.  The  patient  became 
worse  until  an  old  practical  country  doctor  took  hold  of 
the  case,  stopped  all  medication,  made  the  patient  discard 
her  high-heeled  shoes  and  thus  cured  her.  Her  epilepsy  was 
a  reflex  neurosis.  (See  REFLEX  DISORDERS.)  The  simple 
fundamental  laws  of  health  which  culminate  in  the  hygienic 
importance  of  air,  light,  exercise,  proper  food,  cleanliness 
and  excretion,  have  lost  none  of  their  importance.  They 
have  become  more  significant  and  necessary  because  the 
tendency  of  modern  man  is  to  deviate  from  the  normal 
standard  more  and  more.  The  stereotyped  advice  given  to 
patients  to  "get  out  more  and  take  more  exercise"  should 
be  formulated  by  a  deeply  rooted  and  conscious  apprecia- 
tion of  light,  air,  exercise,  etc.,  etc.,  as  therapeutic  agents 
of  fixed  value  in  a  given  case.  For  this  reason  I  have 
availed  myself  of  this  opportunity  to  emphasize  and  repeat 
things  that  every  schoolboy  is  supposed  to  know,  and  that 
many  a  doctor  forgets  when  it  is  most  essential  that  he 
should  remember  them. 


54  MODERN  PHYSIO-THERAPY. 

The  patient's  daily  life  offers  many  a  problem  for  in- 
vestigation and  solution.  Try  to  connect  his  condition  or 
some  conspicuous  feature  thereof  with  the  kind  of  work  he 
does,  the  position  of  his  body  during  his  working  hours, 
the  amount  of  recreation  and  sleep  he  gets,  the  bodily  and 
mental  influences  to  which  he  is  exposed  at  different  times 
or  under  various  conditions,  the  manner  in  which  he  eats 
and  what  he  eats,  the  amount  of  physiological  exercise,  light 
and  air  he  gets,  how  his  home-surroundings  might  react 
upon  him,  and  a  thousand  other  circumstances  suggested  by 
the  personality,  the  surroundings  and  mode  of  living  of  your 
patient.  Remember  the  all-powerful  influence  of  mind  over 
body,  and  analyze  the  factors  that  are  liable  to  react  upon 
his  mind  and  through  it  upon  his  body.  The  mind  should 
be  at  ease  before  we  can  hope  to  re-establish  the  equipoise  of 
the  physical  man.  More  frequently  the  body  acts  upon 
i  he  mind.  In  such  cases  the  body  must  be  regulated  before 
we  can  hope  to  remove  the  mental  effect.  The  mind  is  as 
much  a  part  of  the  man  as  the  body.  Either  must  suffer 
through  the  afflictions  of  the  other. 

The  attempts  which  have  been  made  to  impress  the  mind 
of  patients  through  the  organs  of  special  sense,  especially 
the  eye  and  the  ear,  have  not  only  shown  the  value  of  sen- 
sory suggestions,  but  have  opened  up  a  wonderful  field  of 
clinical  and  experimental  possibilities  especially  in  the  treat- 
ment of  nervous  disorders.  The  development  of  the  beauty- 
sense  by  a  well-planned  system  of  aesthetic  culture  has  be- 
come a  recognized  branch  of  therapeutic  hygiene. 

The  effects  of  different  colors  and  their  combinations  on 
the  eye,  and  through  the  latter  on  the  nervous  system,  can 
be  made  therapeutically  available.  The  colors  of  the  solar 
spectrum  represent  distinct  physical  potercies.  Beginning 
with  the  red  end  of  the  spectrum  and  gradually  passing 
through  the  green  field  to  the  violet  end,  the  ef'ects  on  the 
animal  organism,  respectively,  are  stimulating  ind  seda- 
tive. Finsen  himself,  who  was  not  a  poetic  dreamer  but 
an  exact  scientist,  attributed  the  healthful  influence  of  life 


PERSONAL  HYGIENE.  55 

in  the  country  in  no  inconsiderable  degree  to  the  prevalence 
of  blue  and  green  (sky  and  vegetation).  That  the  undula- 
tions of  light  do  not  affect  merely  the  nerve-structure  of 
the  eye  but  exercise  an  inestimably  profound  influence  over 
the  molecular  elements  of  matter  and  their  vibratory  life- 
manifestations  (see  chapter  on  FORCE-MODALITIES),  is  suffi- 
ciently well  established  to  justify  further  speculation  along 
these  fascinating  border-lines  of  a  new  and  tempting  terri- 
tory. Who  knows  but  what  beauty  is  concord  of  vibrating 
force-modalities  and  that  the  beauty-sense  is  based  on  a 
purely  physical  relation  of  different  forms  of  ethereal  vibra- 
.  tions?  Richard  \Yagner  looked  upon  perverted  taste,  im- 
perfect taste  or  absence  of  taste  as  an  evidence  of  disease,  or 
rather  as  an  evidence  of  a  lower  standard  of  health.  The 
vibratory  character  of  all  force-manifestation  (color,  sound, 
heat,  and  the  corresponding  nerve-force-modalities  which 
give  a  subjective  reality  to  an  objective  potentiality — 
"Kraftumwerthung")  seems  to  give  a  physical  basis  to 
speculations  of  this  kind.  In  regard  to  the  effect  of  sound 
on  the  nervous  system  the  evidence  of  physical  reaction  is 
unquestioned.  Sound  in  its  composite  and  perfected  form 
(music)  is  undoubtedly  an  agent  that  is  capable  of  affecting 
the  potential  energies  of  nerve-molecules  and  cause  the  lat- 
ter to  arrange  themselves  in  a  state  of  more  or  less  close  ag- 
gregation (stimulation,  sedation).  Organisms  that  are  not 
affected  by  these  different  force-modalities  are  certainly  not 
normal,  i.  e.  not  in  a  state  of  perfect  health.  The  lesion  or 
defect  is  somewhere  in  the  finest  and  most  highly  organized 
force-centers.  It  is  the  capability  of  undulations  of  light 
and  sound  reacting  upon  certain  nerve-cells  that  has  given 
us  the  therapy  of  color  and  music.  Both  light  and  sound 
are  capable  of  affecting  (establishing,  changing,  disturb- 
ing) the  relation  of  the  organism  to  its  surroundings. 
Health  has  been  defined :  "A  condition  of  perfect  relation 
of  the  body  to  its  surroundings."  If  this  be  health,  both 
color  and  music  must  be  powerful  therapeutic  agents.  The 
therapy  of  color  (Chromo-therapy)  will  be  referred  to 


56  MODERN  PHYSIO-THERAPY. 

under  the  head  of  Photo-therapy.  Music  offers  a  wide  field 
for  therapeutic  experiment.  It  is  distinctly  a  nerve-tonic,  a 
nerve-restorer.  Reference  to  this  subject  in  medical  jour- 
nals and  books  has  always  been  made  in  a  more  or  less 
jocular  manner.  This  is  unfortunate.  In  this  age  of  nerve- 
exhausting  activity  music  has  become  and  is  a  social- 
economic  necessity.  It  is  a  therapeutic  agent  like  rest  and 
physiological  exercise.  Considerable  experimentation  along 
this  line  has  convinced  me  that  music  will  bring  about 
physiological  and  therapeutic  effects  which  no  other  agent 
or  agents  are  capable  of  producing.  The  music-sense  (capa- 
bility of  reacting  upon  sound-undulations)  is  normally  pres- 
ent in  every  organism.  Its  absence  (Lombroso,  Wagner, 
Nordau)  is  a  sign  of  degeneration.  Shakespeare  fore- 
shadowed this  truth  in  his  characteristic  manner : 

"The  man  who  hath  no  music  in  his  soul, 
And  is  not  moved  by  concord  of  sweet  sounds, 
Is  fit  for  treasons,  stratagems,  and  spoils : — 
Let  no  such   man   be   trusted !" 

The  hygienic  importance  of  light  and  sound  should  teach 
UF.  to  avail  ourselves  of  their  capabilities  in  shaping  the  en- 
vironments of  our  patients,  whose  lives  can  be  made  hap- 
pier and  whose  physical  tone  can  be  improved  by  the  gently 
invigorating  and  preserving  power  of  these  physical  agents. 
In  view  of  all  that  has  been  said  we  are  prepared  to  agree 
with  Wagner,  who  declared  that  artistic  culture  is  a  part 
of  personal  and  public  hygiene. 

A  discussion  of  personal  hygiene  as  a  therapeutic  agent 
would  be  incomplete  without  reference  to  that  most  active, 
most  powerful  and  universally  present  agent  for  good  or 
evil,  the  sexual  instinct.  No  other  force  or  impulse  can 
compare  with  it  in  shaping  the  destinies  of  men  and  nations, 
the  objections  of  prudes  and  religious  sentimentalists  not- 
withstanding. Religion,  patriotism  and  all  the  other  agen- 
cies that  sway  and  move  the  human  heart  dwindle  into  in- 


PERSONAL  HYGIENE. 

significance  if  compared  to  the  sexual  instinct.  The  craving 
for  food  is  the  only  force  that  can  be  said  to  be  equal  to  the 
power  of  the  sex-instinct.  Hunger  is  the  tendency  towards 
self-preservation  on  the  part  of  the  individual.  The  sexual 
instinct  is  the  tendency  toward  self-preservation  on  the  part 
of  the  species.  If  it  were  not  for  hunger  and  love,  the 
human  family  would  soon  cease  to  exist.  Says  Schiller: 

''Methinks  that  while  philosophy 

Does  not  the  world  sustain, 
The  race  of  man  will  live  as  long 
As  love  and  hunger  reign." 

Sexual  hygiene  has  been  and  is  the  noli  me  tangere  of 
moralists,  ministers,  educators  and  physicians.  A  sense  of 
false  modesty,  a  perverted  conception  of  morality  prevents 
the  propagation  of  knowledge  along  this  most  important 
line.  An  agent  of  such  gigantic  power  as  the  sex-instinct 
which  is  ever-active  should  certainly  be  regulated  according 
to  the  physiological  laws  that  control  the  sex-function.  Sex- 
ual starvation,  sexual  overstimulation  and  sexual  perver- 
sions are  frequently  the  causes  of  disease  and  should  be  dis- 
covered by  careful  questioning  and  individualization.  There 
is  no  subject  that  requires  for  its  discussion  as  much  com- 
mon sense,  as  much  freedom  from  religious  or  other  preju- 
dice and  as  much  exact  physiological  knpwledge,  as  the  sub- 
ject of  sexual  hygiene.  Prudes,  religious  cranks  and  hys- 
terical bluestockings  of  both  sexes  forget  that  men  and 
women  are  made  of  flesh  and  blood  and  that  no  amount  of 
reasoning  and  preaching  will  remove  the  most  characteristic 
trait  of  the  animal  body,  i.  e.  the  sexual  appetite.  To  look 
upon  it  as  an  evil  that  ought  to  be  feared  and  crushed,  is  a 
lamentable  mental  abberation.  To  allow  it  to  rule  and  to 
ruin  is  an  equally  deplorable  state  of  affairs.  Sexual 
hygiene  consists  in  applying  the  functions  of  sex  in  a  phys- 
iological manner  for  physiological  purposes.  As  a  part  of 
personal  hygiene  it  presupposes  good  judgment  and  the 
power  of  individualization,  as  far  as  the  medical  adviser  is 


58  MODERN     l'HYS10-THt:«AJ'V. 

concerned.  His  knowledge  and  his  judgment  should  prompt 
him  to  give  advice  and  adapt  it  to  the  individual  require- 
ments. What  the  advice  should  be,  depends  on  a  thousand 
different  circumstances.  I  am  satisfied  to  know  that  I  have 
directed  your  thought  towards  this  all-important  and  much 
neglected  subject.  In  your  diagnostic  and  therapeutic  rea- 
soning the  sexual  habits  of  your  patient  should  find  proper 
consideration.  In  diseases  of  the  nervous  system  the  sexual 
element  not  infrequently  furnishes  the  clew  to  diagnosis  and 
therapy. 

In  applying  the  principles  of  hygiene  to  any  given  clin- 
ical problem  the  criterion  of  judgment  should  be  the  nat- 
ural physical  standard  of  man  under  relatively  primitive 
conditions.  Always  go  back  to  first  principles.  Civilization 
is  not  an  unalloyed  boon.  In  many  respects  it 'has  brought 
about  inferior  conditions  and  appreciable  deviations  from 
the  natural  standard.  In  all  cases  of  disease  try  to  make 
the  habits  and  environments  of  the  patient  conform  to  the 
standard  established  by  Nature.  Hygiene,  after  all,  is 
physiology  applied  to  actual  conditions  for  the  purpose  of 
preserving  health  and  preventing  disease.  It  is,  therefore, 
the  true  groundwork  and  support  of  physiological  thera- 
peutics. 


DIETETICS.  59 


CHAPTER  III. 
DIETETICS. 

"Tell  me  what  you  cat  and  I  will  tell  yon  it'hat  you  are." — 
HIPPOCRATES. 

INASMUCH  as  the  food  which  we  eat  and  drink  is  one 
of  the  conditions  upon  which  the  preservation  of  health  de- 
pends, the  subject  of  dietetics  is  in  reality  a  subdivision  of 
personal  hygiene.  While  it  is  true  that  as  a  purely  hygienic 
measure  the  food  question  is  of  inestimable  importance,  it 
rises  to  the  level  of  a  therapeutic  subject  of  vital  significance 
when  viewed  in  connection  with  the  sick  human  body.  Many 
physicians  attribute  but  little  importance  to  the  question  of 
food,  as  shown  by  the  vagueness  of  the  dietetic  instructions 
given  to  their  patients.  "Do  not  eat  anything  heavy ;"  "Con- 
fine yourself  to  light,  easily  digested  food ;"  "Take  liquid 
food  only."  These  and  similar  vague  directions  are  given 
to  govern  the  patient's  diet.  The  doctor  who  habitually 
makes  statements  of  this  kind  could  not,  if  pressed,  give  an 
intelligent  account  of  what  he  means  by  "heavy  food," 
"light  food,"  etc.  The  truth  of  the  matter  is  that  the  im- 
portance of  the  food-question  both  in  the  preservation  and 
in  the  restoration  of  health  can  not  be  overestimated.  In 
many  chronic  cases  the  dietetic  directions  represent  the  bone 
and  sinew  of  scientific  treatment.  Let  me  begin  our  dis- 
cussion by  a  short  resume  of  first  principles. 

The  process  of  low  oxidation  or  combustion  of  the  body, 
which  is  one  of  the  outward  evidences  of  its  life,  would  soon 
lead  to  a  consumption  or  a  burning  up  of  every  vestige  of 
tissue,  if  Nature  had  not  provided  for  means  of  keeping  the 


60  MODERN  PHYSIO-THERAPY. 

combustion  a-going.  Nature  demands  the  proper  kind  of 
fuel  to  keep  the  fire  from  going  out,  and  to  keep  the  organ- 
ism from  being  consumed.  The  fuel  is  added,  the  process  of 
combustion  goes  on  undisturbed,  material  that  has  been 
utilized  and  is  no  longer  available  is  gotten  rid  of  in  the 
form  of  waste.  Since,  however,  the  stomach  is  not  merely 
a  furnace  and  since  food  is  not  consumed  like  coal  in  a 
furnace,  the  process  of  burning  and  keeping  the  fire  up  is 
a  trifle  more  complex  than  the  burning  up  of  coal  in  a  fur- 
nace. The  fuel  which  we  utilize  in  continuing  the  com- 
bustion of  the  organism  is  not  food  unless  it  is  available 
for  taking  the  place,  quantitatively  and  qualitatively,  of  sub- 
stance that  has  been  consumed.  This  brings  us  to  the 
physiological  definition  of  food,  which  is  any  chemical  sub- 
stance or  combination  of  substances  capable  of  aiding  in 
the  preservation  of  the  quantitative  and  qualitative  integrity 
of  the  body  during  the  process  of  physiological  consumption 
or  of  helping  in  the  keeping  up  of  the  slow  oxidation  which 
constantly  consumes  the  tissues  of  the  body.  This  com- 
plex definition  embraces  the  physiological  meaning  of  food 
and  suggests  the  fundamental  classification  of  foods  as  tis- 
sue-builders and  tissue-consumers.  The  latter  and  likewise 
the  air  we  breathe  conform  to  the  definition  given,  and 
must,  therefore,  be  classified  as  foods.  In  a  dietetic  sense  we 
abstract  from  all  foods  except  those  that  enter  the  organism 
through  the  so-called  alimentary  canal.  Thus  we  get  a 
dietetic  definition  of  our  subject  and  are  prepared  to  say 
that  food  is  any  physiological  tissue-builder  or  tissue-con- 
sumer that  enters  the  organism  through  any  part  of  the  ali- 
mentary canal.  Any  substance  which  enters  the  organism 
through  the  circulation  and  is  not  a  food  in  the  sense  indi- 
cated, is  called  a  poison. 

Foods,  therefore,  must  be  either  tissue-builders  or  tissue- 
consumers.  If  they  aid  in  the  preservation  of  the  structure 
of  the  body,  they  are  tissue-builders  and  are  called  proteids, 
proteins,  albumens,  albumines,  albuminoids  or  nitrogenous 
foods.  These  names  are  synonymous.  Foods  may  add  heat 


DIETETICS.  61 

or  force  by  playing  the  part  of  fuel  and  being  consumed. 
They  are  called  carbo-hydrates.  The  large  amount  of 
liquids  (i.  e.  water)  and  of  mineral  salts  which  the  human 
body  needs  is  to  a  large  extent  contained  in  the  foods  men- 
tioned. 

Quantitatively  water  is  the  most  important  element  in 
the  organism  because  it  represents  approximately  65  per 
cent  of  the  body.  The  body  of  an  adult  requires  about 
eighty  ounces  of  water  daily.  One-third  of  this  quantity 
enters  through  the  solid  foods  in  the  chemical  composition 
of  which  water  represents  nearly  one-half.  In  some  va- 
rieties of  fruit,  water  represents  90  per  cent  and  more.  The 
importance  of  water  as  a  food  can  hardly  be  over-estimated. 
The  blood  needs  water  in  order  to  circulate  with  ease  and 
carry  its  lifegiving  elements  to  every  cell  in  the  body.  The 
cells  of  the  body,  as  Cohen  remarks,  are  distinctly  aquatic 
in  their  habits.  Water  represents  the  largest  bulk  of  their 
substance  and  is  in  one  form  or  another  the  element  in  which 
they  exist.  Water  represents  the  bulk  of  excretion  through 
bowels,  kidneys  and  skin. 

The  tissue-builders  (nitrogenous  foods)  are  principally 
lean  meat,  eggs,  fish,  milk,  cheese,  peas,  beans,  lentils  and 
gluten  of  all  cereals.  This  means  that  these  foods,  as 
far  as  their  chemical  composition  is  concerned,  contain  a. 
larger  relative  amount  of  tissue-building  elements  than  of 
carbo-hydrates  and  mineral  salts. 

The  tissue-consumers  (force  producers,  carbo-hydrates) 
are  mainly  fats,  starch,  sugar,  gum  and  alcohol.  The  fats 
are  frequently  called  hydro-carbons. 

Many  of  the  foods  in  daily  use  really  belong  to  both 
classes  inasmuch  as  they  contain  approximately  the  proper 
proportion  of  tissue- building  and  tissue-consuming  ele- 
ments. Milk,  meat,  eggs,  wheat  and  oats  contain  both  kinds 
of  food-elements.  Ordinarily,  the  animal-foods  are  con- 
sidered tissue-builders  (nitrogenous)  and  vegetables  tissue- 
consumers  ( carbo-hydrates  ) . 


62  MODERN  PHYSIO-THERAPY. 

The  Digestive  Process. 

The  process  of  introducing  food  into  the  organism  for 
the  purposes  of  digestion,  assimilation  and  nutrition  begins 
in  the  mouth  where  the  food  is  macerated  by  the  grinding 
action  of  the  teeth  and  slowly  moulded  into  a.  soft  mass  by 
the  admixture  of  the  secretion  of  the  parotid,  submaxillary, 
sublingual  and  buccal  (mucous  and  serous)  glands.  The 
secretion  of  these  glands  is  known  as  saliva  and  is  an  alka- 
line fluid  which  has  the  property  of  changing  starch  into 
sugar  at  a  moderate  temperature. 

The  function  of  the  mouth  as  an  organ  of  perfect  di- 
gestion depends  upon  (i)  tne  condition  of  the  teeth,  which 
are  the  organs  of  maceration;  (2)  the  slow  moulding  of  the 
food  into  a  soft  mass,  it  being  necessary  to  grind  slowly  in 
order  to  macerate  thoroughly  and  allow  the  fluids  of  the 
mouth  to  permeate  the  mass  perfectly;  (3)  the  good  con- 
dition of  the  physiological  digestive  fluids  of  the  mouth. 
The  latter  point  refers  particularly  to  cleanliness  of  the 
mouth,  by  which  foreign  more  or  less  offensive  substances 
are  excluded  and  thus  kept  from  causing  a  deterioration  of 
the  normal  mouth-fluids.  Keeping  the  mouth  clean  is,  in 
more  senses  than  one,  a  praiseworthy  task.  The  filthy  habits 
of  the  tobacco-chewer  and  the  equally  disgusting  rumina- 
tions of  the  female  gum-habitue  are  offensive  alike  to  the 
aesthetic  sense  and  to  the  physiological  instinct.  Both  habits 
are  frequently  productive  of  digestive  disturbances.  The 
filth  (bacterial  and  otherwise)  of  an  unclean  mouth  may  be 
carried  into  the  stomach  and  absorbed  into  the  system.  The 
fact  that  the  digestive  action  of  saliva  ceases  above  and 
below  certain  temperatures,  proves  the  harmful  effects  of 
very  hot  and  of  extremely  cold  drinks  or  morsels,  e.  g.  the 
habitual  drinking  of  ice-water.  That  the  continued  action 
of  extreme  heat  or  cold  is  bound  to  injure  the  mucous  mem- 
brane of  the  mouth,  is  readily  understood. 

After  a  morsel  of  food  has  been  prepared  in  the  mouth, 
it  passes  through  the  oesophagus  into  the  stomach,  where  it 
is  acted  upon  by  the  so-called  gastric  juice,  which  is  an  acid 


DIETETICS.  63 

secretion  containing  pepsin,  hydrochloric  acid  and  a  mild 
curdling  ferment  called  rennet.  The  gastric  juice  acts  upon 
the  tissue-builders  (lean  meat,  eggs,  milk,  cheese,  fish,  peas, 
beans  and  the  gluten  found  in  wheat,  oats  and  other  cereals) 
and  starts  the  process  of  disintegrating  fat-cells  and  chang- 
ing the  fats  into  fatty  acids  and  glycerines.  The  gastric 
juice  likewise  converts  cane-sugar  into  grape-sugar  and  in 
this  way  prepares  it  for  absorption  into  the  system.  Cellu- 
lose (the  substance  out  of  which  the  cells  are  constructed 
which  contain  the  starch  granules)  is  not  digested  in  the 
human  stomach.  It  must  be  broken  up  by  mastication  or 
cooking,  otherwise  it  remains  totally  indigestible.  This 
holds  good  in  regard  to  all  starchy  vegetables  and  cereals. 

Food  remains  in  the  stomach  from  one  to  six  hours,  de- 
pending on  the  kind  of  food,  the  manner  of  its  preparation, 
the  mixture  of  different  food-substances  and  the  condition 
of  the  stomach.  Coagulated  albumen  is  hard  to  digest.  In 
the  digestion  of  meat  this  is  an  important  point.  A  piece  of 
raw  lean  meat,  if  its  fibrous  elements  are  thoroughly  broken 
up  by  maceration,  pounding,  scraping  or  grinding,  is  easily 
digested.  The  longer  meat  is  cooked,  especially  roasted  or 
fried,  the  }ess  easily  digestible  it  becomes  on  account  of  the 
coagulating  effect  of  heat  on  albumen.  It  becomes  harder 
to  digest  the  more  fat  meat  contains,  on  account  of  the 
limited  action  of  the  gastric  juice  on  fat.  If  lean  meat  or 
eggs  are  fried  in  fat,  they  accordingly  become  harder  to 
digest. 

The  condition  of  the  stomach  determines,  to  a  certain 
extent,  the  relative  speed  of  the  process  of  gastric  digestion. 
There  may  be  a  dearth  or  an  excess  of  acid  in  the  gastric 
juice.  The  greater  the  amount  of  acid,  the  more  rapid  the 
digestion  of  nitrogenous  foods.  The  stomach  may  tem- 
porarily lack  the  power  of  digestion.  During  its  period  of 
activity  it  requires  approximately  six  times  more  arterial 
blood  than  ordinarily.  If  the  required  supply,  for  some 
reason  or  other,  is  not  present,  digestion  will  necessarily 
be  slow.  Cerebral  hyperemia  (mental  anxiety,  study,  etc.) 


64  MODERN    PHYSIO-THERAPY. 

may  draw  the  blood  >  to  the  brain  away  from  the 
stomach  and  thus  weaken  the  digestive  power  of  the 
stomach.  The  general  system  may  not  require  any 
food,  and  through  the  sympathetic  nervous  system  an- 
nounce this  fact  to  the  stomach.  The  latter  responds 
by  declining  to  ask  for  food  (physiological  anorexia; 
absence  of  hunger  or  appetite,  nature's  demand  for  food). 
The  stomach  may  be  the  seat  of  disease  and  through  this 
fact  be  unable  to  digest,  especially  if  afflicted  by  the  mani- 
fold varieties  of  gastric  dyspepsia.  Sluggish  digestion  may 
be  due  to  chemical  action  of  one  kind  of  food  upon  another 
variety,  e.  g.  the  presence  in  the  same  stomach  of  albuminous 
food  (egg)  and  tannin,  a  large  percentage  of  which  is  con- 
tained in  strong  tea.  The  tannin  would  precipitate  the  white 
of  egg  and  render  it  totally  indigestible. 

The  change  which  food  undergoes  in  the  stomach  is  the 
second  act  in  the  process  of  digestion.  Little  by  little  the 
food  is  discharged  into  the  small  intestines  through  the 
pyloric  end  of  the  stomach.  The  peristaltic  movements  of 
a  stomach  after  a  meal  affect  the  ramifications  of  the  solar 
plexus  posteriorly  like  gentle  stimulating  massage.  Xerve- 
energy  is  assembled  in  the  abdominal  nervous  system.  Ten- 
sion in  all  other  parts  of  the  nerve-supply  of  the  body  is  re- 
lieved. The  organism  lapses  into  a  delightful  condition  of 
repose.  Man  is  at  peace  with  himself  and  with  all  the 
world.  The  brain  is  easy  owing  to  reduced  blood-pressure. 
It  enjoys  a  state  of  absolute  rest,  which  frequently  merges 
into  a  condition  of  actual  somnolence.  I  have  never  taken 
the  old  German  adage  seriously  which  tells  you  that 

"After  eating  you  must  talk, 
Or  must  take  a  little  walk." 

It  surely  refers  to  an  hour  or  two  after  eating,  not  imme- 
diately after  the  meal.  The  after-dinner  nap  is  a  physiolog- 
ical luxury  which  is  sanctioned  by  that  Providence  to  whom 
we  bow  in  deference  for  being  so  fearfully  and  wonderfully 
made.  With  some  persons  the  after-dinner  nap  is  a  phys- 
iological necessity. 


DIETETICS.  65 

The  most  important  part  of  the  digestive  process  takes 
place  in  the  small  intestines,  which  represent  a  tube  about 
twenty  feet  in  length.  The  part  which  is  known  as  the 
duodenum  is  equal  in  point  of  importance  to  the  stomach 
and  is  sometimes  called  the  second  stomach.  The  digestive 
ferments  are  furnished  by  the  pancreas  (dissolution  of  ni- 
trogenous food  elements,  splitting  up  of  starch,  saponifica- 
tion  of  fats)  and  the  liver  (preparing  fats  for  absorption,  ren- 
dering the  intestinal  contents  alkaline,  preventing  fermenta- 
tion) and  numerous  small  intestinal  glands  (changing 
starches  into  sugar,  preventing  fermentation).  Small  pro- 
jections along  the  entire  intestinal  canal,  called  villi,  take 
up  particles  of  digested  food  and  cause  them  to  be  received 
by  the  so-called  lacteal  vessels,  which  assemble  their  con- 
tents in  the  receptaculum  chyli  and  the  thoracic  duct,  and 
finally  discharge  them  into  the  left  subclavian  vein.  The 
chyle  is  lifted  upward  from  the  abdominal  cavity  through 
the  mechanism  of  breathing,  the  upward  movement  of  the 
chyle  being  facilitated  by  the  valves  in  the  thoracic  duct 
which  prevent  regurgitation  of  the  fluid.  The  fluid  be- 
comes a  part  of  the  blood  and  is  carried  to  all  parts  of  the 
body. 

The  contents  of  the  small  intestines  diminish  constantly, 
owing  to  the  absorbent  action  of  the  villi,  and  practically 
represent  a  mass  of  residue  or  waste  when  they  are  dis- 
charged into  the  large  intestines  through  the  ileo-caecal 
valve.  In  the  large  intestines  no  digestion  takes  place.  The 
residue  of  food  and  the  admixture  of  mucus,  etc.,  from  the 
bowel  is  moulded  into  fecal  matter  and  finally  discharged 
through  the  anus  in  a  state  of  fermentation.  Physiologically 
the  large  intestines  represent  an  unnecessary  encumbrance. 
1'athologically  and  etiologically  they  are  of  the  greatest  im- 
portance. (See  AUTO-INTOXICATION.) 

The  Hygiene  and  Ethics  of  Food. 
How  often  should  man  eat?    Under  normal  physiolog- 
ical conditions  man  should  eat  when  he  is  hungry.     In  the 


66  MODERN  PHYSIO-THERAPY. 

normal  body  hunger  is  the  cry  of  the  system  for  sustenance. 
It  is  impossible  to  say  what,  when,  how  often,  how  much  a 
man  should  eat.  Civilized  man  is  in  many  respects  the 
product  of  unnatural  surroundings  and  conditions,  and  thus 
the  results  achieved  by  civilization  (so-called)  frequently 
present  perversions  and  not  logical  evolutions  of  Nature's 
intentions.  Decayed  teeth,  dyspepsia  and  constipation  are 
some  of  the  gifts  of  civilization  in  a  dietetic  way.  Even  the 
domesticated  animals  share  in  these  doubtful  blessings.  The 
punishments  which  outraged  Nature  metes  out  to  man  for 
his  deviations  from  the  fixed  standard,  follow  in  logical  se- 
quence. They  are  the  thousand  varieties  of  disease.  In  this 
sense  disease  is  an  artificial  product  which  appears  as  the 
necessary  sequence  of  given  premises. 

What  should  man  eat?  A  type  of  man  which  is  dis- 
tinctly the  product  of  modern  civilization  is  the  meat-eater 
par  excellence,  who  manages  to  sustain  his  organism  by 
ir.cans  of  immense  quantities  of  nitrogenous  foods  served  at 
the  rate  of  three  or  four  meals  per  day.  Habit  has  caused  this 
man  to  crave  meat  and  to  imagine  that  meat  alone  will  sat- 
isfy his  desire  for  food.  Meat  is  food  to  him,  everything  else 
is  an  unimportant  side-dish.  The  liquid  elements  which  his 
organism  needs,  are  introduced  in  the  form  of  strong  stimu- 
lating liquors.  That  the  man  with  carnivorous  instincts 
should  want  liquor  is  not  surprising.  He  fills  his  stomach 
with  tissue-building  elements  and  naturally  craves  for 
stimulants  to  take  the  place  of  the  force-producing  or  heat- 
furnishing  carbo-hydrates.  He  is  constipated  because  his 
food  leaves  but  little  waste.  His  circulation  is  constantly  in 
an  uproar,  his  blood  not  sufficiently  liquefied,  his  nerve-cen- 
ters are  in  a  state  of  continued  agitation.  As  a  result,  the 
central  organ  of  circulation  is  weak.  This  man  is  the  type 
of  a  patient  who  quickly  succumbs  to  an  acute  disease  like 
pneumonia.  The  heart  can  not  stand  the  strain.  The  or- 
ganism which  has  been  sustained  by  immense  quantities  of 
nitrogenous  foods,  collapses,  because  the  power  of  appro- 
priating food  of  such  quality  and  in  such  quantity  has  been 


DIETETICS.  67 

weakened.  The  fever-process  destroys  the  organism  which 
is  not  accustomed  to  rapid  and  intense  combustion.  The 
meat-eater  can  not  stand  capital  surgical  operations  as  read- 
ily as  the  vegetarian.  The  modern  man  who  practically 
lives  on  meat  is  constantly  paving  the  way  for  some  form 
of  disease  or  other.  He  is  nervous  beyond  endurance,  like 
the  carnivorous  tiger  in  his  cage.  His  instincts  gradually 
become  those  of  the  carnivorous  beast.  His  intellectual 
powers  wane  while  the  instincts  of  his  animal  nature  in- 
versely increase.  He  craves  liquor  to  equalize  the  dispropor- 
tion between  tissue-builders  and  tissue-consumers.  Finally 
his  stomach  and  bowels  succumb  to  the  strain  and  the  end- 
less chain  of  diseases  of  the  organs  of  assimilation  with  their 
complications  and  sequelae  begins.  The  urea-laden  renal 
excretion  of  the  meat-eater  undermines  the  function  of  the 
kidneys  and  chronic  nephritis  is  the  result.  Skin-diseases 
of  variable  type  follow  in  the  wake  of  an  excessive  meat- 
diet,  not  to  speak  of  rheumatism  which  is  the  meat-eater's 
disease  par  excellence. 

The  champions  of  a  nitrogenous  diet  point  to  the  mag- 
nificent physique  of  the  typical  meat-eater,  the  lion,  as  an 
example  of  beauty  and  superb  strength.  The  illustration  is 
not  well  chosen.  Aside  from  the  fact  that  the  lion  belongs 
to  an  entirely  different  species,  he  eats  a  great  deal  at  one 
time,  but  this  does  not  happen  every  day  nor  every  other  day. 
In  proportion  he  eats  much  less  meat  than  the  typical  car- 
nivorous man,  and  exercises  the  muscles  of  his  body  much 
more.  Lions  in  captivity  become  lazy  and  even  sickly — for 
obvious  reasons. 

The  large  apes  resemble  the  species  of  man  more  than 
any  other  group  of  animals.  The  apes  are  vegetarians,  very 
healthy  and  strong,  are  long-lived  and  possessed  of  fine  sen- 
sibilities and  instincts.  In  captivity  they  become  sickly, 
weak,  learn  to  eat  meat  and  appropriate  many  bad  traits 
characteristic  of  the  human  species.  Civilized  apes  usually 
die  of  tuberculosis.  The  influence  of  civilization  and  cap- 
tivity on  the  human  and  the  simian  species  is  interestingly 


68  MODERN  PHYSIO-THERAPY. 

shown  by  Darwin  ("Origin  of  Species")  and  Brehm 
("Thierleben").  The  latter  tells  of  a  French  naturalist  in 
Africa  whose  party  ran  short  of  supplies  and  was  compelled 
to  live  on  berries,  nuts,  etc.  Not  being  familiar  with  some 
of  the  varieties  of  fruit  which  the  country  produced,  the 
men  allowed  themselves  to  be  guided  by  the  instincts  of  a 
large  ape  they  had  caught  and  tamed.  Whatever  the  ape 
ate,  they  proceeded  to  eat.  Whatever  he  refused,  they  did 
not  touch.  The  ape  instinctively  avoided  poisons  and  other 
substances  not  suitable  for  eating. 

The  natural  history  of  the  entire  animal  kingdom  testi- 
fies to  the  influence  of  diet  over  physical  and  mental  quali- 
ties. The  finer  instincts  and  evidences  of  soul-life  are  ap- 
parent in  the  plant-eater  more  than  in  the  meat-eater.  The 
dove  is  the  emblem  of  gentleness,  the  lamb  that  of  purity. 
The  noblest  of  all  domestic  animals,  the  steadfast  friend  of 
man  behind  the  plow  and  on  the  field  of  battle,  is  a  vegeta- 
rian, the  horse.  The  horse  combines  all  the  excellent  traits 
of  character  that  we  are  wont  to  admire:  courage,  gentle- 
ness, fiery  temper,  generosity,  intelligence,  strength,  en- 
durance and  devotion  to  his  master.  Another  of  our  do- 
mesticated animal-friends,  the  dog,  is  brutal  and  savage 
when  fed  to  meat  (the  bull-dog),  but  represents  the  highest 
type  of  animal-intelligence  and  keen  instincts  if  he  is  largely 
or  entirely  a  vegetarian  (the  hunting  dog).  The  hawk  and 
the  eagle  are  exclusively  carnivora  and,  accordingly,  carnal 
and  cruel  in  their  habits.  In  point  of  character  and  intelli- 
gence the  herbivorous  animals  are,  throughout  the  whole 
animal  kingdom,  superior  to  the  meat-eaters. 

The  physical  effects  of  diet  among  the  animals  is  no  less 
characteristic.  The  plant-eaters  possess  marvelous  endur- 
ance (birds  of  passage,  camels,  horses,  elephants,  hunting- 
clogs).  The  meat-eaters  are  vigorous  and  can  make  a  won- 
derful display  of  strength,  but  they  possess  little  endurance. 
The  lion  engages  in  a  terrific  battle,  and,  after  it  is  over, 
feasts  on  the  mangled  carcass  of  his  adversary  and  spends 
his  time  lazily  in  his  haunts  until  hunger  compels  him  to  seek 


DIETETICS.  69 

another  bloody  encounter.  Endurance  is  the  characteristic 
physical  trait  of  the  vegetarian.  The  winners  in  athletic 
contests  where  it  is  a  question  of  endurance  (swimming, 
walking,  running,  etc.)  are  usually  plant-eaters.  The  en- 
during power  of  the  vegetarian  is  shown  in  the  work  done 
by  the  Chinese  coolies,  who  are  not  giants  in  strength  and 
stature,  but  apparently  never  wear  out.  Who  has  not  mar- 
veled at  the  accomplishments  of  the  little  brown  men  of 
Japan  who  are  principally  rice-  and  fish-eaters  ?  The  world 
has  never  seen  more  admirable  traits  of  mind  and  heart  than 
those  recently  displayed  by  the  pagans  of  Nippon.  These 
are  facts  too  well  known  to  require  any  further  demonstra- 
tion. 

The  lesson  which  the  study  of  animal  life  teaches  us  is 
too  plain  to  be  misunderstood.  It  conveys  three  dietetic 
principles  which  are  as  firm  and  .unshakable  as  the  Rock  of 
Gibraltar : 

1.  Modern  man  eats  too  much  and  too  often  in  propor- 
tion to  his  physiological  wants ; 

2.  Modern  man  eats  too  much  meat  in  proportion  to  the 
amount  of  carbo-hydrates ; 

3.  The  treatment  of  all  general  diseases  and  many  local 
troubles  must  begin  with  a  rational  dietetic  regime. 

I  do  not  wish  to  be  understood  as  saying  that  man 
should  abstain  from  meat  entirely.  While  total  abstinence 
in  this  respect  would  certainly  improve  man  physically  and 
morally,  and  would  take  away  the  sting  of  many  an  avoid- 
able disease  and  prolong  the  life  of  the  average  man,  it 
would  involve  many  hardships  and  inconveniences  because 
it  would  be  at  variance  with  the  established  order  of  things. 
In  the  large  cities  it  is  almost  impossible  to  be  a  practical 
physiological  dietarian.  The  average  man  thinks  it  is  im- 
possible to  live  and  remain  well  and  strong  without  meat, 
lo  disabuse  the  mind  of  man  of  this  erroneous  impression, 
would  be,  in  its  last  consequences,  an  epoch-making  accom- 
plishment in  social  economy.  The  belief  in  the  dietetic 


70  MoDKKN     1'IIYSIO-THKKAPY. 

necessity  of  meat  is  a  sample  of  the  ignorance  that  covers 
physician  and  layman  alike  with  its  nightly  shades. 

The  meat-habit  (overindulgence  in  meat)  does  not  dif- 
fer from  the  opium-habit  or  any  other  bad  habit.  It  is  a 
habit,  never  a  physiological  necessity.  It  is  perpetuated  by 
a  perversion  of  the  sense  of  taste,  not  by  a  physiological  de- 
mand of  the  system.  The  need  of  tissue-building  elements  is 
amply  filled  by  a  mixed  diet  of  vegetables  (principally)  and 
meat  (sparingly).  Meat  in  modest  quantity  should  never  be 
served  more  than  once  a  day.  In  cases  of  constipation  it 
should  not  be  given.  It  leaves  but  little  waste  to  engage  the 
peristaltic  activity  of  the  large  bowel,  and,  therefore,  favors 
the  absorption  of  toxines  from  the  fermenting  residue.  Most 
meat-eating  animals,  especially  in  captivity,  are  constipated. 
Compare  the  frantic  defecatory  efforts  of  the  constipated 
canine  with  the  pastoral  tranquillity  of  the  ruminating 
bovine  during  the  bountiful  act  of  excretion  through  the 
primes  vies. 

I  could  not  illustrate  the  clinical  physiology  of  food  bet- 
ter than  by  a  short  reference  to  rheumatism.  Rheumatism 
is  a  disease  of  nutrition.  Uric  acid,  which  is  the  form  in 
which  the  nitrogenous  derivatives  of  food  exist  when  they 
have  nearly  reached  the  last  stage  of  chemical  change,  is 
present  in  excess  when  nitrogenous  foods  are  taken  in  undue 
quantity.  When  there  is  deficient  oxidation  or  a  lack  of 
exercise,  the  uric  acid  is  partly  retained,  gets  into  the  blood- 
and  lymph-circulation  and  causes  the  familiar  symptoms  of 
rheumatism.  The  modern  treatment  consists  in  giving  but 
little  nitrogenous  food  (i.  e.  give  it  in  a  vegetable  form), 
in  stimulating  excretion  and  in  augmenting  oxidation.  (See 
RHEUMATISM.)  The  same  lo^ic  prevails  in  the  treat- 
ment of  many  other  conditions  due  to  deranged  metabolism. 
Let  it  be  remembered  that  many  vegetables  contain  the 
proper  physiological  proportion  of  nitrogenous  elements. 
They  are  capable  of  preserving  the  human  frame  in  prime 
condition  with  all  physical  and  mental  forces  at  their  best,  as 
shown  by  the  example  of  Sir  Isaac  Newton,  who  lived  to  the 


DIETETICS.  71 

ripe  old  age  of  ninety  and  was  a  lifelong  vegetarian.  A 
vegetable  diet  stimulates  tissue-change  because  carbo-hy- 
drates are  most  easily  oxidized,  prevents  the  accumulation 
of  redundant  fat  and  waste,  keeps  the  body  active  and  the 
mind  sharp  and  clear.  Shakespeare  was  a  wonderfully 
keen  judge  of  human  nature,  even  in  its  physical  aspects. 
The  words  spoken  by  Julius  Caesar  convey  a  remarkably 
correct  lesson  in  dietetics : 

"Let  me  have  men  about  me  that  are  fat ; 
Sleek-headed  men  and  such  as  sleep  o'  nights; 
Ycnd  Cassius  has  a  lean  and  hungry  look, 
He  thinks  too  much :  such  men  are  dangerous." 

Caesar  is  not  afraid  of  the  well-fed  and  ponderous  meat- 
eater,  but  he  fears  the  alertness,  the  ever-active  tempera- 
ment and  never-failing  endurance  of  the  wiry  Cassius,  who 
is  evidently  a  vegetarian.  From  a  purely  physiological 
standpoint  the  Friday  ordinance  of  the  Catholic  Church  has 
much  to  recommend  it.  If  the  ordinance  were  extended  to 
every  second  day,  beneficent  results  would  most  certainly 
follow.  Much  good  could  be  done  if  meat  were  rigidly  ex- 
cluded from  the  bill  of  fare  in  all  penal  institutions,  as  is 
done  in  some  parts  of  Germany.  This  would  be  a  practical 
application  of  a  physiological  principle,  /.  c.  that  the  animal 
functions  are  stimulated  by  nitrogenous  foods,  while  carbo- 
hydrates preserve  the  finer  instincts  and  emotions  of  human 
nature. 

The  proper  food  for  a  well  man  is  a  mixed  diet  of  nitrog- 
enous elements  and  carbo-hydrates.  The  proportion 
should  be  determined  by  our  knowledge  of  the  fact  that 
nitrogenous  elements  are  contained  in  many,  in  fact  in  all 
vegetables.  When  peas,  beans,  lentils  and  wheat  are  con- 
sumed in  large  quantities,  meat  is  not  needed  to  furnish  the 
desirable  proportion  of  nitrogenous  food.  A  small  amount 
of  rare  lean  meat  once  every  day  or  every  other  day  should 
be  a  plentiful  sufficiency  for  any  one.  People  should  be 
taught  to  look  upon  raw  fruit  as  being  a  most  important 


72  MODERN  PHYSIO-THERAPY. 

food.  Eggs  and  milk  should  occupy  a  prominent  position  as 
food  elements.  Vegetables  (raw  or  cooked)  are  supposed 
to  be  the  dietetic  mainstay  of  the  healthy  man.  Meat  should 
always  be  given  the  exceptional  position  of  a  dietetic  luxury. 
It  is  not  a  dietetic  necessity.  There  is  no  physiological  or 
other  kind  of  reason  why  an  erroneous  notion  of  this  kind 
should  be  perpetuated. 

Diet  as  a  Therapeutic  Agent. 

As  a  therapeutic  measure  in  the  treatment  of  disease,  the 
diet  of  a  patient  should  receive  painstaking  attention.  Re- 
membering the  role  which  food  plays  in  the  physiological 
process  of  combustion  and  keeping  in  mind  the  sluggish 
metabolism  which  represents  the  raison  d'etre  of  most 
chronic  diseases  (i.  e.  impairment  of  reparative  power),  we 
are  prepared  to  appreciate  the  therapeutic  value  of  the 
carbo-hydrates  which  are  immediately  concerned  in  the 
burning  up  of  the  tissues  and  in  the  forcing  of  the  change 
of  tissue.  In  conditions  characterized  by  intensified  com- 
bustion (febrile,  hectic),  the  importance  Of  nitrogenous 
feeding  is  apparent  ("feed  fevers!"  Fothergill).  When  the 
organism  is  losing  ground  without  febrile  reaction,  the  in- 
dication for  a  suitable  mixed  diet  is  plain.  If  the  stomach 
or  bowels  present  certain  pathologic  evidences  of  a  local 
character,  the  chemistry  of  the  food  administered  should  be 
taken  into  consideration.  Thus,  the  diet  of  a  patient  with  a 
dilated  stomach  should,  for  obvious  reasons,  be  suggested  by 
the  necessity  of  preventing  fermentation.  (See  DYSPEP- 
SIA). In  a  general  way  we  can  systematize  therapeutic 
dietetics  in  the  form  of  four  fundamental  laws,  to  wit : 

1.  Loss  of  weight  without  fever  calls  for  a  mixed  diet; 

2.  Continued  fever  is  an  indication  for  nitrogenous  food ; 

3.  Sluggish  metabolism  which  is  typical  of  most  chronic 
diseases  requires  carbo-hydrates ; 

4.  In  disorders  of  the  stomach  or  bowels  the  diet  should 
be  regulated  by  the  chemistry  and  mechanism  of  the  process 
of  digestion  with  careful  individualization. 


DIETETICS.  73 

The  first  sub-division  refers  to  cases  of  lowered  vitality 
and  general  depression  that  present  ill-defined  diagnostic 
features,  such  as  the  thousand  and  one  different  functional 
diseases  of  the  nervous  system,  e,  g.  nervous  prostration 
(unless  caused  by  a  dilated  stomach),  the  nervous  disorders 
of  the  menopause,  conditions  produced  by  lack  of  fresh  air 
and  sunshine,  etc.,  etc. 

Typhoid  fever  is  a  classical  example  of  a  continued  fever. 
A  continuous  low  fever,  e.  g.  in  tuberculosis,  should  dietet- 
ically  be  met  by  tissue-builders.  In  all  these  cases  combus- 
tion is  accelerated  and  intensified,  and,  for  this  reason, 
carbo-hydrates  in  excess  are  not  indicated. 

\\  herever  and  whenever  oxidation  is  sluggish,  causing 
waste-products  to  be  retained  in  the  blood,  the  lymph-fluids, 
the  bowels,  the  lungs,  etc.,  etc.,  the  diet  should  mainly  con- 
sist of  carbo-hydrates  and  foods  that  are  largely  aqueous. 
This  should  be  the  rule  in  all  diseases  of  general  and  local 
nutrition,  e.  g.  rheumatism,  skin-diseases. 

In  cases  of  dilated  stomach  all  articles  of  food  that  are 
fermentable  should  be  withheld.  The  generation  and  ac- 
cumulation of  gas  would  dilate  the  stomach  still  more.  In 
cases  of  overbad  dity,  nitrogenous  foods  would  be  easily  di- 
gested. For  mechanical  reasons  solid  foods  would  be  con- 
tra-indicated in  gastric  ulcer,  intestinal  ulcerations  (typhoid 
fever),  etc. 

The  dietetic  position  of  different  foods  is  indicated  by 
the  following  list,  which  shows  at  a  glance  the  salient  points 
of  therapeutic  interest  in  regard  to  the  more  common  foods 
in  daily  use.  The  foods  in  common  use,  in  the  order  of 
their  nitrogenous  food-value,  are  cheese  (33  to  43  p.  c.), 
beans  (25  p.  c.},  lentils  (25  p.  c.),  mushrooms  (24  p.  c.), 
ham  (24  p.  c.),  peas  (23  p.  c.),  spring-chicken  (23  p.  c.), 
lean  beef  (22  p.  c.),  duck  (21  p.  c.),  lean  pork  (20  p.  c.), 
veal  (19  p.  c.),  pigeon  (19  p.  c.),  salted  herring  (19  p.  c.), 
medium  beef  (18  p.  c.).  game  (18  p.  c. ),  chicken  (18  p.  c.), 
meat-sausage  (18  p.  c.  and  less),  oatmeal  (16  p.  c.),  lamb 
(15  p.  c.),  fat  pork  (14  p.  c.),  corn  (14  p.  c.),  eggs  (12 


74  MODERN  PHYSIO-THERAPY. 

p.  c.),  wheat  (ii  p.  c.),  fish  (10  p.  c.  and  less),  noodles 
(9  p.  c.),  rice  (7  p.  c.),  rye  (6  p.  c.),  oysters  (6  p.  c.), 
cream  (5  p.  c.),  milk  (4  p.  c.),  potatoes,  spinach  and  cab- 
bage (2  p.  c.). 

Foods  in  common  use,  in  the  order  of  their  carbo- 
hydrate value,  are  beets  and  carrots  (95  p.  c.),  rice  (77 
p.  c.),  noodles  (77  p.  c.),  wheat  (73  p.  c.),  corn  (71  p.  c.), 
honey  (70  p.  c.),  oatmeal  (64  p.  c.),  peas  (57  p.  c.),  beans 
(56  p.  c.),  lentils  (55  p.  c.),  mushrooms  and  wheat  (51 
p.  c.),  rye  (48  p.  c.),  potatoes  (21  p.  c.),  cherries  (15  p.  c.), 
apples  and  pears  (12  p.  c.),  plums  (8  p.  c.),  spinach  and 
string  beans  (6  p.  c.),  strawberries  (6  p.  c.)  cabbage  (5 
p.  c.  and  less). 

Foods  in  common  use,  in  the  order  of  their  fat-contents, 
are  butter  (85  p.  c.),  bacon  (79  p.  c.),  fat  pork  (47  p.  c. ), 
meat-sausage  (40  p.  c.  and  less),  ham  (37  p.  c.),  cream 
(29  p.  c.),  cheese  (25  p.  c.  and  less),  salted  herring  (17 
p.  c.),  beef  (10  p.  c.  and  less),  lamb  (9  p.  c.),  veal  (8  p.  c.), 
oatmeal  (6  p.  c.). 

Foods  in  common  use,  in  the  order  of  the  quantity  of 
water  they  contain,  are  cabbage,  watermelons,  cow's-milk 
(93  to  88  p.  c.),  strawberries,  pears,  apples,  potatoes,  cher- 
ries (88  to  75  p.  c.),  lean  beef,  lamb,  lean  pork,  chicken, 
pigeon,  game,  duck,  eggs  (75  to  70  p.  c. ),  cheese,  fat  pork, 
salted  herring,  wheat,  rye  (48  to  42  p.  c.),  ham  (28  p.  c.), 
mushrooms  (17  p.  c.),  cereals  (15  to  10  p.  c.),  butter,  bacon 
( 10  p.  c.). 

All  foods  mentioned  contain  a  small  admixture  in  varia- 
ble proportion  (average  5  p.  c.)  of  mineral  salts  and  waste. 

It  will  be  noticed  that  beans,  lentils,  peas  and  mushrooms 
head  the  list  of  nitrogenous  foods,  and  that  there  is  only 
one  variety  of  meat  (spring-chicken)  that  comes  near  these 
vegetables  in  tissue-building  value.  Cheese  is  the  best  nitrog- 
enous food.  The  large  percentage  of  carbo-hydrates  which 
beans,  peas,  lentils  and  mushrooms  contain,  give  them  a  sin- 
gular fitness  as  parts  of  a  mixed  diet.  From  a  purely  nutri- 
tional point  of  view  they  surpass  any  and  all  other  foods. 


DIETETICS.  75 

The  nitrogenous  foods  form  the  blood,  the  organs  and 
tissues  of  the  body.  The  fats  are  either  deposited  as  such 
in  the  system  or  are  burnt  up  (oxidized)  through  the  action 
of  the  oxygen  in  the  body,  leaving  waste  or  ashes  behind  in 
i he  form  of  water  and  carbonic  acid.  The  carbo-hydrates 
are  the  real  fuel.  They  burn  up  and,  in  so  doing,  produce 
force  and  heat.  The  relative  amount  of  nitrogenous  matter 
in  the  body  is  not  influenced  by  work  or  muscular  exertion. 
Exertion  means  more  oxygen,  more  fuel,  more  intense  com- 
bustion and,  therefore,  more  carbo-hydrates.  A  working 
n:an  of  me  !ium  stature  needs  daily  about  2,818  grams  of 
water,  100  grams  of  digestible  albumen,  55  grams  of  fat, 
500  grams  of  carbo-hydrates,  32  grams  of  mineral  salts,  and 
7.54  grams  of  atmospheric  oxygen.  Food  represents  latent 
energy.  To  express  the  energy  stored  in  a  certain  quantity 
of  food,  the  energy  is  measured  in  units,  called  calories.  A 
calorie  is  the  amount  of  heat  required  to  raise  one  gram  of 
water  i°  C.  Approximately  one  gram  of  dried  nitrogenous 
food  represents  4,000  calories,  the  same  quantity  of  carbo- 
hydrates Jr._oo  calories,  the  same  amount  of  fat  9,500  calo- 
ries. Adding  the  number  of  calories  to  the  amount  of  nitrog- 
enous or  protcid  units  (building  material),  we  obtain  the 
actual  physiological  value  of  the  food  estimated.  Knowing 
the  physiological  requirements  of  the  body  as  expressed  in 
calories  and  nitrogenous  units,  and  knowing  the  number  of 
calories  and  nitrogenous  units  contained  in  any  given  food, 
v.e  are  able  to  estimate  the  food  required  by  a  body  of  given 
size  and  doing  a  certain  amount  of  work. 

The  length  of  time  which  is  consumed  in  the  digestion  of 
special  foods  is  an  item  of  some  importance.  The  following 
list  indicates  approximately  in  what  space  of  time  the  diges- 
tion of  different  foods  under  ordinary  circumstances  may 
be  considered  complete. 

In  one  hour.     Cooked  rice.     Boiled  pigs  feet.    Tripe. 

In  one  hour  and  thirty  minutes.  Beaten  raw  eggs. 
Boiled  trout.  Barley-soup.  Sweet  soft  apples.  Roasted 
game.  Parsnips.  Calf's  brains. 


76  MODERN  PHYSIO-THERAPY. 

In  one  hour  and  forty-five  minutes.    Cooked  brain.  Sago. 

In  tuo  hours.  Tapioca.  Barley.  Milk  (boiled).  Fried 
beef-liver.  Raw  eggs.  Sour  soft  apples.  Sour  cabbage. 
Raw  milk.  Codfish.  Bouillon. 

In  tzi'o  hours  and  fifteen  minutes.  Fried  eggs.  Cooked 
turkey. 

In  tivo  hours  and  thirty  minutes.  Cooked  gelatine.  Raw 
beef  chopped.  Roasted  turkey.  Wild-goose  roast.  Shoat. 
Spring  lamb.  Cooked  beans.  Sponge-cake.  Fried  potatoes. 
Cabbage.  Cooked  marrow.  Sweet-bread. 

In  two  hours  and  forty-five  minutes.  Chicken  fricassee. 
Omelette.  Milk  pudding.  Cooked  beef.  Sour  hard  raw 
apples.  Raw  oysters. 

In  three  hours.  Soft-boiled  eggs.  Fried  bass.  Lean 
beef,  medium.  Fried  steak.  Pickled  pork.  Roasted  lamb. 
Pickled  pork  stewed.  Boiled  lamb.  Chicken-soup.  Bean- 
soup.  Apple  dumplings.  Corn  cakes  (baked).  Fried 
pork-chops. 

In  three  hours  and  thirty  minutes.  Fried  oysters.  Pickled 
pork  fried.  Pickled  lamb.  Corn-bread.  Carrots  (boiled). 
Pork-sausage  fried.  Brown  butter.  Oyster-soup.  Lean 
beef  fried.  Beef  boiled  in  mustard.  Melted  butter.  Old 
cheese.  Lamb-soup.  Fresh-baked  wheat-bread.  Turnips 
boiled.  Boiled  potatoes.  Hard-boiled  eggs.  Succotash. 
Boiled  beets.  Raw  ham.  Caviar.  Herring.  Smoked 
tongue. 

In  four  hours.  Pickled  salmon  boiled.  Pickled  beef 
stewed.  Fried  veal.  Fried  chicken.  Chicken-stew.  Fried 
cluck.  Vegetable  beef-soup.  Beef-heart  fried.  Bacon. 

In  four  hours  and  thirty  minutes.  Pickled  dried-beef 
boiled.  Pickled  pork  fried.  Marrow-soup.  Pickled  pork 
boiled.  Veal  pot-roast.  Lamb-suet  boiled.  Boiled  cab- 
bage. 

In  five  hours.    Fried  pork.    Beef-suet  boiled. 

In  logical  sequence  I  ought  to  discuss  the  preparation  of 
foods,  for  hygienic  cooking  is  a  subdivision  and  an  integral 
part  of  dietetics.  It  does  not,  however,  concern  the  physi- 


DIETETICS.  77 

cian  directly.  In  connection  with  the  preparation  of  foods 
we  must  bear  in  mind  that  the  civilized  man  of  to-day  is  not 
by  any  means  the  ideal  or  normal  man.  The  finely  culti- 
vated sensibilities  of  the  former  are  perversions  of  the  orig- 
inal natural  instincts  of  the  latter.  The  olfactory  as  well  as 
the  gustatory  sense  does  not  respond  to  the  natural  stimuli, 
but  requires  new  and  strong  sensations.  This  is  strikingly 
the  case  in  regard  to  the  foods  we  eat  and  drink  and  to  the 
manner  of  serving  them.  That  the  normal  man  can  live  on 
and  is  amply  satisfied  with  the  food  which  nature  offers  di- 
rectly (water,  milk,  raw  fruit  and  vegetables),  there  is  no 
doubt.  The  raw-food  fad  which  recently  engaged  the  at- 
tention of  Eastern  society,  proved  that  even  the  civilized 
stomach  does  very  well  with  raw  food.  The  remarkable 
cure  of  not  a  few  dyspeptics  by  the  raw-food  diet,  is  worthy 
of  passing  notice.  The  educated  sense  of  taste  and  the  re- 
fined sense  of  smell  resists  food  of  this  kind  because,  through 
habit,  appetite  for  and  relish  of  food  depend  largely  upon 
the  impressions  which  are  made  upon  the  senses  of  taste  and 
smell.  Thus  the  art  of  cooking  originated  by  which  the 
palate,  the  nose  and  the  stomach  can  be  stimulated,  pleased 
and  satisfied  in  a  thousand  different  ways.  To  please  a 
slowly  degenerating  sense  of  taste  became  the  task  of  the 
cook,  whose  resourcefulness  and  artful  devices  have  made 
him  an  important  factor  in  the  affairs  of  the  human  family. 
It  Napoleon's  cook  had  been  able  to  please  the  stomach  of 
the  grim  Corsican  in  its  never-ending  whims  and  caprices, 
he  would  have  influenced  the  trend  of  history  in  no  uncer- 
tain manner.  I  have  referred  to  the  sense  of  taste  of  the 
modern  man  as  an  instance  of  perversion  or  degeneration. 
Nature  punishes  digressions  from  the  normal  standard  by 
inflicting  the  offender  with  disease.  Diseases  of  the  stom- 
ach are  more  common  than  any  other.  The  reason  is  that 
the  stomach  is  sinned  against  oftener  than  any  other  part  or 
organ  of  the  body.  People  sin  against  their  stomachs  in 
six  different  ways,  to  wit :  I.  They  eat  and  drink  too  much ; 
2.  They  eat  too  large  a  proportion  of  nitrogenous  food ;  3. 


78  MODERN  PHYSIOTHERAPY. 

Food  is  not  prepared  properly;  4.  The  stomach  is  subjected 
to  too  much  violent  stimulation ;  5.  The  stomach  is  exposed 
to  too  many  thermic  shocks ;  6.  Alcohol  and  other  irritating 
stimulants  are  used  at  the  wrong  time  and  in  too  large 
quantities.  In  the  treatment  of  all  gastric  disorders  these  six 
points  serve  a  good  diagnostic  and  therapeutic  purpose. 

The  first  thiee  points  have  already  been  touched  upon. 
The  fourth  point  refers  to  the  use  of  spices  and  condiments. 
The  latter  are  added  to  foods  in  order  to  please  the  palate 
or  the  olfactories.  Taken  in  excess  these  spices  and  condi- 
ments can  not  help  but  be  productive  of  harm.  (See  SKIN- 
DISEASES.)  A  sense  of  taste  that  always  craves  for  highly 
seasoned  food  and  an  excess  of  salt,  pepper,  mustard,  etc., 
is  not  normal.  Inflammatory  or  catarrhal  reaction  of  the 
gastric  mucous  membrane  is  bound  to  follow.  The  craving 
for  liquor  usually  coexists.  The  use  of  spices  and  condi- 
ments at  all  times  and  in  all  foods  is  certainly  the  specific 
cause  in  not  a  few  cases  of  stomach-trouble.  The  presence 
of  sharp  and  irritating  substances  in  the  stomach  can  not 
help  but  impair  the  mucous  membrane.  The  tannin  and  the 
alkaloids  contained  in  coffee  and  tea  are  objectionable  for 
similar  reasons,  if  the  two  beverages  mentioned  are  par- 
taken of  in  large  quantities  and  in  largely  concentrated  form. 
Much  of  what  has  been  said  concerning  the  use  of  stimu- 
lants holds  good  in  regard  to  tobacco.  Tobacco  in  moderate 
quantity  is  hygienically  not  objectionable  in  any  form,  al- 
though the  chewing  habit  is  hardly  an  indicator  of  personal 
cleanliness.  If  used  constantly,  tobacco  becomes  a  poison, 
capable  of  destroying  the  functional  integrity  of  the  heart 
and  of  the  nervous  system. 

Thermic  shocks  are  thought  by  many  to  be  the  most 
fruitful  source  of  stomach-trouble.  The  sudden  chilling  of 
the  gastric  mucous  membrane  by  cold  drinks  (ice-water, 
very  cold  beer,  ice-cream),  especially  when  the  stomach  is 
relatively  empty,  is  certainly  not  calculated  to  improve  its 
physical  condition.  Ice-water  is  by  virtue  of  its  tempera- 
ture a  pathogenic  element  that  must  be  reckoned  with.  It  is 


DIETETICS.  79 

distinctly  an  American  product  and  its  use  a  distinctly 
American  form  of  idiocy.  Dumb  brutes  have  never  been 
known  to  be  guilty  of  the  follies  which  man  (homo  ^a- 
picns)  constantly  commits.  While  fresh,  pure  drinking- 
water  is  a  necessity  and  a  luxury,  its  temperature  should  be 
in  keeping  with  the  tolerance  of  the  body.  The  effect  of  an 
ice-cold  drink  on  the  unprotected  surface  of  an  empty  stom- 
ach is  bound  to  shock  the  nerve-supply  of  the  stomach.  It 
contracts  the  blood-vessels  of  the  gastric  mucous  membrane 
and  induces  a  reaction  which  leaves  the  membrane  con- 
gested and  irritated.  It  must  be  remembered  that  the  tem- 
perature of  the  water  has  nothing  whatever  to  do  with  its 
fitness  to  quench  thirst.  An  equal  amount  of  warm  or  hot 
water  would  serve  this  purpose  as  well  as  ice-water.  Cold 
water  pleases  the  palate.  The  moment  a  sufficient  amount  of 
fluid  has  been  taken  up  by  the  system  to  supply  the  phys- 
iological demand,  thirst  ceases. 

The  use  of  alcohol  at  the  wrong  time  and  in  the  wrong 
\vay  is  a  prolific  source  of  stomach-disorder.  An  alcoholic 
drink  on  an  empty  stomach  is  not  proper.  The  "eye-opener," 
from  the  standpoint  of  health,  is  to  be  condemned.  It  is  an 
irritant  to  the  mucous  membrane  and  can  not  be  indulged  in 
habitually  without  harm  ensuing.  The  prevalence  of 
whisky-drinking  in  this  country  is  a  fact  much  to  be  de- 
plored. \Yhisky  is  a  medicinal  stimulant,  never  a  beverage. 
1'ettenkofer  considers  whisky-drinking  on  a  par  with  co- 
caine-eating. It  is  the  abuse  of  a  splendid  food  (alcohol). 
Ke  suggests  the  substitution  of  beverages  that  are  whole- 
some, nutritious  and  contain  alcohol  in  comparativly  small 
quantities,  e.  g.  very  light  wines  and,  above  all,  the  popu- 
larization of  good  beer.  Therein  lies  the  practical  solution 
of  the  temperance-problem.  Whisky-drinkers  are  usually 
drunkards,  beer-drinkers  hardly  ever.  Even  in  large  quan- 
tities beer  affects  the  stomach  mainly  through  its  bulk.  On 
a  full  stomach — c<rteris  paribus — a  mild  stimulating  bever- 
age (light  wine  or  good  beer)  is,  as  Sturm  remarks,  a  verita- 
ble gift  of  the  gods.  It  aids  digestion  and  promotes  metabol- 


80  MODERN  PHYSIO-THERAPY. 

ism.  Strong  alcoholic  drinks  (over  6  p.  c.  of  alcohol)  re- 
tard and  finally  check  digestion.  They  precipitate  the  pep- 
sin of  the  gastric  juice  and  coagulate  the  food-albumen,  ren- 
dering the  latter  less  soluble.  The  digestive  power  of  the 
pancreatic  secretion  is  affected  by  small  quantities  of  alcohol. 
One  ounce  of  brandy  delays  the  digestion  of  a  meal  for  a 
half-hour  to  an  hour. 

That  food  is  bound  to  influence  the  progress  of  disease 
and  must,  therefore,  be  of  great  consequence  therapeutically, 
is  readily  seen  when  we  consider  its  importance  during 
health.  Our  discussion  of  the  chemistry  of  foods  has  taught 
us  that  food  affects  metabolism  directly,  and,  therefore,  is 
capable  of  striking  at  the  very  foundation  of  physical  life. 
In  chronic  diseases  which  are  not  characterized  by  a  dis- 
tinct waste  or  a  continuous  loss  of  weight,  oxidation  is  slug- 
gish and  imperfect.  The  general  symptoms  in  these  condi- 
tions are  caused  by  the  retention  of  waste-products  or,  as 
P.ouchard  says,  by  auto-intoxication.  (See  FUNCTIONAL 
DISORDERS.)  The  therapeutic  importance  of  the  carbo- 
hydrates in  these  conditions  is  plain.  Try  to  conceive  the 
physical  life  of  the  sick  person  as  a  physiological  problem. 
The  dietetic  features  of  the  treatment  will  suggest  them- 
selves as  necessary  conclusions  of  your  reasoning.  Re- 
member that  75  p.  c.  of  all  chronic  diseases  are  primarily 
due  to  disorders  of  the  organs  of  digestion.  The  results  in 
practice  justify  the  hyperbole  which  seems  to  be  contained 
in  this  statement.  At  any  rate,  you  will  never  have  cause  to 
regret  the  prominence  which  you  give  to  the  stomach  in  your 
therapeutic  reasoning.  Dietetic  knowledge  compensates  for 
lack  of  diagnostic  or  therapeutic  skill  in  not  a  few  instances. 

The  perversions  which  modern  civilization  has  wrought 
in  the  ideas  and  instincts  of  man  have  affected  his  stomach 
and  its  habits.  In  view  of  this  fact  a  return  to  the  natural- 
ness and  simplicity  of  normal  man  seems  imperative. 
Knowledge  of  physiology  should  be  a  part  of  the  inner  con- 
sciousness of  a  physician.  It  should  precede  diagnosis  and 


DIETETICS.  81 

therapy.  The  dumb  animals  practice  dietetic  philosophy 
instinctively.  They  do  not  deviate  from  the  natural  stand- 
ard as  long  as  man  does  not  coerce  them.  Then  they,  too, 
degenerate  and  lose  their  fitness  to  survive  in  specific  per- 
fection. It  seems  to  be  only  too  true  that  "civilization  is 
the  biggest  lie  that  has  ever  been  told  in  one  word"  (Nor- 
dau).  It  has  improved  man  in  accidentals,  but  impaired 
him  in  essentials.  Queen  Catharine  in  speaking  about  Wol- 
sey,  said  that  he  was  "a  man  of  an  unbounded  stomach." 
This  is  a  good  description  of  modern  man  and  a  short  but 
significant  resume  of  the  etiology  of  most  chronic  diseases. 


82  MODKRN  PHYSIO-'!' nKR. 


CHAPTER  IV. 

THE  PHYSIOLOGICAL   EFFECTS  OF   HEAT 
AND  COLD. 

THE  increased  interest  which  physicians  are  taking  in 
the  theory  and  practice  of  hydro-therapeutics1  is — from  a 
therapeutic  point  of  view — a  characteristic  sign  of  the  times. 
It  is  not  so  very  long  ago  since  the  average  physician  would 
decline  to  even  for  one  moment  seriously  discuss  hydro- 
therapy  as  a  legitimate  method  of  medical  treatment.  Fifty 
years  ago  the  French  Academy  of  Medicine  gave  it  as  its 
opinion  that  hydro-therapy  was  a  dangerous  form  of  ex- 
periment. Even  nowadays  the  scientific  hydro-therapist  is 
hardly  given  a  hearing  unless  it  be  by  the  progressive  men 
in  the  profession,  who,  unfortunately,  do  not  constitute  the 
majority.  Hydro-therapy  has  fought  a  long  and  bitter  bat- 
tle and  owes  its  recognition  by  the  progressive  men  in  the 
profession  to  its  own  intrinsic,  scientific  value,  to  its  wide 
range  of  applicability,  and  to  its  truly  wonderful  clinical 
efficacy.  The  prejudice  against  water-applications  is  due  to 
several  distinct  factors.  Up  to  within  a  comparatively  re- 
cent period,  the  exponents  of  practical  hydro-therapy  were 
uneducated  empirics,  who  enshrouded  themselves  and  their 
work  in  a  great  deal  of  mystery  to  impress  the  credulous  and 
ignorant.  In  this  way  the  method  came  into  disrepute 


lHydro-;hcraf>y  includes  the  therapeutic  uses  of  heat  and  cold 
if  these  agents  are  applied  by  means  of  water.  Thermo-therapy  refers 
to  the  therapeutic  uses  of  elevated  temperatures  (heat)  irrespective 
of  the  carrier  which  is  used.  Its  meaning  is  limited  to  the  effects 
of  heat.  I  have  confined  the  discussion  of  the  physiology  of  heat 
and  cold  to  hydro-therapy  because  the  latter  is  the  classical  expo- 
nent of  the  whole  subject  and — physiologically  and  clinically — more 
important  than  any  other  method  of  applying  heat  and  cold. 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.        83 

through  the  men  who  were  identified  with  it  and  through 
the  manner  in  which  it  was  applied.  The  prejudice  which 
in  this  way  was  engendered  against  the  method  among  the 
practitioners  of  medicine  became  more  and  more  estab- 
lished, there  being  but  little  effort  made  by  physicians  to  in- 
form themselves  concerning  the  method  which  they  were 
condemning.  In  addition  to  this  the  successful  application 
of  hydro-therapy  presupposes  an  exact  physiological  knowl- 
edge and  familiarity  with  pathological  processes  not  essen- 
tial in  the  administration  of  drugs  and  in  the  application  of 
drug-methods.  Another  reason  why  hydro-therapy  has  as 
yet  failed  to  find  a  place  in  the  clinical  armamentarium  of 
most  physicians  is  the  fact  of  its  being  necessarily  encum- 
bered with  an  amount  of  technical  detail,  taking  up  time  and 
labor  of  both  physician  and  patient.  For  all  these  reasons 
hydro-therapy  has  as  yet  not  conquered  the  place  which  it  so 
richly  deserves.  Some  physicians  are  inclined  to  look  upon 
it  as  a  fad,  an  ephemeral  innovation  which  will  be  relegated 
to  oblivion  whenever  the  charm  of  novelty  is  worn  off  or 
whenever  some  later  fad  commands  professional  attention. 
Few  seem  to  know  that  hydro-therapy  is  among  the  oldest, 
if  not  the  oldest  clinical  method  known.  To  readers  of 
Latin  the  grateful  appreciation  expressed  by  Horace  con- 
cerning the  splendid  work  of  Musa,  who  had  cured  a  num- 
ber of  prominent  Roman  bon-vivants  of  gout  and  similar 
afflictions  simply  by  water  applications,  is  familiar.  Long 
before  the  golden  age  of  the  Roman  Empire  water  as  a 
therapeutic  agent  was  held  in  high  esteem  in  Greece  and 
Egypt,  according  to  the  statement  made  by  Herodotus.  The 
Romans  were  famous  for  the  grandeur  and  luxury  of  their 
baths,  where  various  hydro-therapy  procedures  were  con- 
stantly en  vogue  for  the  treatment  of  different  ailments. 
During  the  Middle  Ages  the  hydro-therapists  of  Italy  and 
France  enjoyed  a  vast  reputation.  One  of  the  greatest  med- 
ical men  of  the  sixteenth  century,  Ambroise  Pare,  was  an 
enthusiastic  admirer  of  water  applications.  With  the  ap- 
proach of  the  nineteenth  century  hydro-therapy  was  grad- 


84  MODERN  PHYSIO-THERAPY. 

ually  usurped  by  empirics  and  charlatans,  who,  by  the  in- 
discriminate use  of  powerful  hydro-therapeutic  methods  and 
by  the  bitterness  and  persistency  with  which  they  antago- 
nized all  other  therapeutic  measures  and  scientific  medicine 
generally,  brought  the  whole  subject  of  hydro-therapy  into 
disfavor  with  the  profession  at  large.  Yet  it  can  not  be 
gainsaid  that  some  of  the  empirics,  notably  Priessnitz,2  con- 
tributed very  largely  to  the  elaboration  of  the  subject  of 
hydro-therapy,  especially  as  far  as  the  clinical  uses  of  the 
various  methods  and  the  improvement  of  technical  resources 
were  concerned.  Practically,  the  renaissance  of  hydro- 
therapy  within  the  confines  of  legitimate  medicine  was  con- 
summated by  the  introduction  of  the  cold-water  treatment 
of  typhoid  fever.  Since  that  time  increased  interest  in  the 
subject  has  been  manifested  among  the  progressive  mem- 
bers of  the  profession.  Numerous  books,  especially  Win- 
ternitz's  great  work,  attest  to  the  earnestness  with  which 
the  subject  is  received  by  some  of  the  brightest  medical  in- 
tellects of  the  day.  The  number  of  strictly  scientific  hos- 
pitals and  sanitariums  devoted  to  hydro-therapy  is  increas- 
ing from  year  to  year.  Hydro-therapy  has  achieved  its 
greatest  triumphs  in  the  very  home  of  scientific  thought, 
Germany,  where  already  at  a  number  of  universities  special 
chairs  for  the  theoretical  and  clinical  teaching  of  hydro- 
therapy  have  been  established.  It  remains  to  be  seen  which 
American  institution  will  be  progressive  enough  to  admit 
hydro-therapy  into  its  curriculum  of  studies  as  an  inde- 
pendent and  recognized  branch  of  medicine.  Verily,  by  vir- 
tue of  its  physiological  exactness  and  clinical  usefulness, 
hydro-therapy  is  entitled  to  a  prouder  and  more  dignified 
place  among  the  various  departments  of  medical  teaching. 


2It  is  true  that  Vincenz  Priessnitz  was  not  an  educated  phy- 
sician, but  he  was  a  medical  genius,  who  instinctively  felt  what 
many,  after  years  of  study,  do  not  grasp.  A  doctor  of  medicine 
is  not  necessarily  a  physician. 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.        85 

The  Physiology  of  Water  Applications. 

Water  as  a  therapeutic  agent  is  employed  both  externally 
and  internally.  The  science  of  hydro-therapy,  however,  deals 
principally  with  its  external  use,  i.  e.  the  various  methods  of 
applying  it  to  the  skin.  I  shall,  therefore,  confine  myself 
to  the  discussion  of  the  physiological  principles  underlying 
the  diverse  methods  of  employing  water  externally  and  the 
effects  aimed  at.  Water  in  and  of  itself  is  not  a  therapeutic 
agent,  to  which  could  be  attributed  certain  remedial  poten- 
cies. "It  serves,  however,  as  a  carrier  of  certain  physical 
forces  and  properties  which  are  capable  of  producing  char- 
acteristic and  profound  physiological  effects  upon  the  system 
through  the  instrumentality  of  that  most  delicate  and  re- 
sponsive of  finely  organized  structures,  namely  the  skin. 
There  are  other  agents,  which  possess  in  a  measure  the  same 
physical  properties.  From  a  practical  point  of  view,  how- 
ever, water  is  by  far  the  most  available  of  all  these  agents, 
since  it  is  inexpensive,  easily  obtained,  and  can  be  utilized 
in  any  number  of  ways  and  forms.  Thus,  as  a  carrier  of 
temperature,  air  might  be  utilized  as  effectively  as  water,  but 
the  manner  of  making  it  subservient  to  our  purpose  and  the 
method  of  handling  it  entails  much  technical  difficulty.  Ex- 
perience has  shown  water  to  be  the  most  available  of  agents 
to  serve  as  a  carrier  of  heat  and  cold.  This  fact  furnishes 
the  practical  basis  for  hydro-therapy.  The  logic  of  hydro- 
therapy,  then,  becomes  apparent  if  we  analyze  the  physiolog- 
ical effects  of  heat  and  cold  primarily  upon  the  skin,  and 
secondarily  upon  the  system  at  large. 

The  idea  of  temperature  is  intimately  bound  up  in  and 
inseparable  from  all  vital  processes.  All  organic  beings  are 
affected  by  different  degrees  of  heat  and  cold.  The  outward 
manifestations  of  life  in  every  organism  and  in  every  part  of 
an  organism  are  dependent  upon  the  degree  of  temperature 
by  which  the  organism,  wholly  or  in  part,  is  surrounded. 
The  manifestations  of  life  are  retarded  or  accelerated  or 
entirely  suspended  by  the  variations  of  temperature.  This 
holds  good  in  regard  to  the  most  perfectly  organized  bodies 


86  MODERN  PHYSIO-THERAPY. 

as  well  as  to  the  simplest  forms  of  organic  life.  Ciliary  mo- 
tion, ameboid  movement,  the  vesicular  contractions  of  the 
infusoria,  the  contractions  of  muscular  fibers,  etc.,  etc.,  all 
react  upon  thermic  influences.  Ordinary  degrees  of  heat  and 
cold  respectively  accelerate  or  retard  motion,  while  extreme 
degrees  completely  arrest  it,  and,  if  continued,  endanger  the 
vitality  of  the  organic  body.  Inasmuch  as  the  motor  func- 
tion of  cellular  bodies  is  affected  by  heat  or  cold,  this  effect 
is  not  characteristic  of  the  action  of  heat  or  cold  alone. 
Any  irritant,  e.  g.  contact  with  another  body,  is  sufficient  to 
affect  the  movements  of  the  organism  for  the  time  being. 
Heat  or  cold,  therefore,  primarily  act  as  irritants  or  ex- 
citants pure  and  simple.  The  study  of  physiological  proc- 
esses within  the  animal  economy  of  warm-blooded  animals 
has  taught  us  that  these  processes  are  necessarily  dependent 
upon  a  certain  degree  of  heat.  Heat  makes  possible  and 
accompanies  the  conversion  of  chemical  elements  into  the 
forces  and  functions  which  constitute  the  life  of  the  organ- 
ism. Furthermore,  we  know  that  heat  is  the  principal 
product  of  the  metamorphotic  and  functional  activity  which 
takes  place  within  the  animal  economy.  In  the  present  state 
of  our  knowledge  we  can  assume  with  a  reasonable  degree 
of  certainty  that  heat  and  function,  meaning  by  the  latter 
the  sum-total  of  force-manifestation  within  the  organism, 
are  dependent  upon  each  other,  are  convertible  into  each 
other;  that  organic  life,  therefore,  is  a  condition  produced 
by  a  heatmaking  process  within  the  organism.  We  can 
deduct,  furthermore,  that  function  and  heat-production  are 
in  direct  proportion  to  each  other.  If  we  intensify  the  one, 
we  ipso  facto  increase  the  other;  if  we  depress  the  one, 
diminution  of  the  other  must  necessarily  follow.  Since  the 
functional  activity  of  the  organism,  however,  either  is  con- 
cerned in  the  taking-up  of  food  (nutrition  in  its  wide  physi- 
ological sense)  or  in  the  expulsion  of  waste  (excretion),  it 
stands  to  reason  that  the  degree  of  nutritive  and  excretive 
function  is  in  direct  proportion  to  the  degree  of  heat  pres- 
ent. A  low  degree  of  temnerature  means  slow  oxidation, 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.        87 

retarded  tissue-metamorphosis,  and,  therefore,  slow  nutri- 
tion and  lessened  function.  This  holds  good  in  regard  to  the 
whole  organism  as  well  as  to  each  and  every  part  individ- 
ually. These  physiological  considerations  enable  us  to  draw 
a  conclusion  of  momentous  importance:  If  we  can  control 
(intensify  or  depress  at  will)  the  heat-producing  process, 
then  we  can  regulate  oxidation,  functional  activity,  nutri- 
tion and  tissue-change.  These  strictly  physiological  pre- 
mises embolden  us  to  go  even  further  in  our  conclusions.  If 
we  can  accelerate  or  retard  the  chemico-physiological  ac- 
tivity in  the  organism  at  large,  or  locally  in  any  of  the 
organs  of  the  body,  then  we  certainly  have  snatched  from  the 
hands  of  Nature  the  magic  wand  which  holds  at  bay  the 
enemies  of  our  bodies,  which  preserves  our  physical  well- 
being  during  the  onslaught  of  disease-producing  germs  and 
elements,  which  sustains  our  body  in  its  integrity,  and  which 
enables  the  fittest  to  survive.  That  magic  wand  is  FEVER. 
Fever  is,  as  we  at  this  late  day  are  ready  to  admit,  acceler- 
ated oxidation  of  the  tissues  of  the  organism,  hastened  nu- 
trition. All  the  engines  of  the  organism  are  v/orking  at  full 
speed,  large  aggregations  of  slack  and  waste  are  hurled 
through  the  gateways  of  excretion,  new  food-material  is  de- 
voured and  consumed  by  the  roaring  furnace  within. 
Finally  the  organism  returns  to  its  normal  speed  and  amount 
of  work,  the  vicious  elements  of  disease  have  been  elimin- 
ated, regeneration  has  taken  place,  health  again  supervenes. 
That  such  a  process  of  rapid  oxidation  (fever)  should  be  ac- 
companied by  an  increased  amount  of  heat  (elevated  tem- 
perature) is  but  natural  to  assume  in  view  of  the  previously 
quoted  physiological  laws  governing  the  vital  processes 
within  the  organism.  That  we  can  radically  modify  the  pro- 
cesses of  heat-production  and  by  so  doin^  necessarily  af- 
fect oxidation  and  nutrition,  that  we  can,  consequently,  ar- 
bitrarily bring  about  a  fever-process  even  to  the  extent  of 
causing  local  or  general  temperature  to  rise  and  fall,  is  an 
undisputed  fact,  and  can  be  abundantly  demonstrated  by  ex- 
periment. 


88  MODERN  PHYSIO-THERAPY. 

The  purely  physical  effect  of  heat  and  cold  upon  tissue 
of  all  kinds,  both  dead  and  living,  is  expansion  and  contrac- 
tion. The  molecular  elements  of  the  tissues  respond  to  the 
exciting  cause  and  arrange  themselves,  as  a  result,  at  greater 
or  less  distance  from  each  other,  the  intensity  of  the  effect 
being  in  proportion  to  the  difference  between  the  tempera- 
ture of  the  tissue  acted  upon  and  the  temperature  acting 
upon  it.  The  more  marked  the  contrast  between  the  two 
temperatures,  the  greater  the  effect  of  contraction  and  ex- 
pansion. The  immediate  result  of  this  purely  physical 
phenomenon  is  the  production  of  a  dynamic  element,  a  force, 
resembling  in  its  manifestations  an  electrical  or  magnetic 
potency,  which,  as  all  physicists  know,  springs  into  exist- 
ence  whenever  temperatures  of  different  degrees  come  into 
contact  and  which  travels  in  the  direction  of  the  lower  tem- 
perature. If  the  substance  acted  upon  is  a  living  organism, 
the  electrical  potency  generated  will  travel  along  the  paths 
of  the  inherent  vital  energies  or  currents  of  nerve-force 
with  which,  as  DuKois  Raymond  has  shown,  all  living  tis- 
sue is  constantly  charged.  Thus,  heat  and  cold  are  capable 
of  affecting  the  .amount  and  power  of  the  currents  of  nerve- 
force  circulating  in  our  nerve-fibers,  and  through  the  brain 
and  spinal  cord  make  impressions  upon  the  whole  (motor 
and  sensory)  nervous  system  (Winternitz). 

Whenever  water  the  temperature  of  which  is  higher  or 
lower  than  that  of  the  body-surface  comes  into  contact  with 
the  skin,  this  contact  is  perceived  by  the  cutaneous  nerves  as 
a  sensation  of  heat  or  cold.  The  capability  of  the  skin- 
nerves  to  perceive  heat  and  cold  is  called  the  "thermic 
sense,"  and  manifests  itself  within  certain  degrees  of  tem- 
perature below  which  and  above  which  the  impressions  are 
merely  those  of  pain.  Extreme  heat  and  extreme  cold  re- 
semble all  other  nerve-stimuli  or  nerve-excitants  inasmuch 
as  they  impair  or  even  completely  suspend  the  nerve-potency 
of  receiving  and  conducting  sensations.  A  state  of  tempo- 
rary anaesthesia  is  produced.  A  high  but  not  excessively 
high  temperature  of  short  duration,  likewise  a  low  but  not 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.        89 

excessively  low  temperature  of  short  duration,  intensifies  the 
susceptibility  of  the  skin  for  tactile  impressions,  i.  e.  the 
skin  becomes  hyperaesthetic.  If  the  application  is  of  longer 
duration,  tactile  impressions  become  more  and  more  faint, 
— anaesthesia  of  the  skin  supervenes.  Hence  we  speak  of 
overstimulation  and  subsequent  exhaustion  of  the  functional 
power  of  the  cutaneous  sensory  nerves.  In  connection  with 
this  subject  it  is  of  interest  to  note  that  not  a  few  physiolo- 
gists, among  them  Blix,  Goldscheider  and  Herzen,  recognize 
the  thermic  sense  as  being  bound  up  in  certain  fine  nerve- 
endings  entirely  distinct  from  the  end-bulbs  commonly  cred- 
ited with  receiving  tactile  impressions.  Some  of  them,  nota- 
bly Blix,  whose  ingenious  experiments  were  made  in  the 
physiological  laboratory  of  old  Upsala,  recognize  two  dis- 
tinct thermic  senses  (one  of  heat,  one  of  cold),  with  sep- 
arate terminal  structures  and  independent  central  connec- 
tions. All  tnese  authors,  however,  agree  and  numerous 
physiological  and  clinical  experiments  go  to  show  that  heat 
and  cold  applied  to  the  skin  are  capable  of  affecting  (in-  and 
de-creasing)  and  altering  the  innervation  of  the  organism 
wholly  or  in  part.  In  connection  with  this  subject  it  may  be 
of  interest  to  call  attention  to  the  statements  made  by  Krebs 
and  Heimann  in  explanation  of  the  sedative  action  of  com- 
plete immersion  of  the  body  in  warm  water.  That  aqueous 
elements  do  enter  through  the  skin  (endosmosis)  has  been 
demonstrated.  It  is  claimed  that  in  this  way  an  edematous 
condition  of  the  peripheral  nerve-endings  is  produced,  caus- 
ing the  molecules  within  these  endings  to  move  sluggishly. 
Nerve-impulses  are  received  and  carried  with  less  prompt- 
ness and  a  state  of  comparative  quietude  of  the  nervous  sys- 
tem is  brought  about. 

These  purely  thermic  effects  on  the  skin-nerves,  and 
through  these  on  the  nervous  system,  are  immediately  fol- 
lowed by,  and  can  not  practically  be  separated  from,  char- 
acteristic effects  on  certain  vital  processes  within  the  or- 
ganism which  are  wholly  or  largely  controlled  by  the  nerv- 
ous system.  These  vital  processes  go  to  make  up  the  two 


90  MODERN  PHYSIO-THERAPY. 

fundamental  functions  performed  by  the  machinery  of  the 
body,  i.  e.  nutrition  (self-preservation  of  the  organism)  and 
excretion  (expulsion  of  waste).  Inasmuch  as  nutrition  of  a 
part  is  dependent  upon  the  blood-supply  of  the  part,  we  are 
ready  to  admit  that  to  control  the  blood-supply  means  to 
regulate  nutrition.  Furthermore,  since  the  degree  of  func- 
tional activity  of  any  organ  is  in  direct  proportion  to  the 
amount  of  arterial  blood  and  vice  versa,  we  are  prepared 
to  say  that,  if  we  can  control  the  blood-supply  of  the  organs 
of  excretion,  we  can  regulate  excretion.  To  control  nutri- 
tion and  excretion  by  regulating  the  blood-circulation  means 
to  control  the  very  processes  by  which  the  life  of  the  or- 
ganism is  preserved.  That  these  statements  do  not  contain 
visionary  notions,  but  strictly  scientific  truths  which  can  be 
verified  by  clinical  demonstration,  the  following  physiolog- 
ical considerations  will  serve  to  show. 

A  thermic  stimulus  perceived  by  the  cutaneous  nerves  is 
communicated  to  nerve-centers  situated  in  the  brain,  cord 
and  in  the  peripheral  ganglia.  Through  these  the  stimulus 
is  reflected  to  the  vaso-motor  nerves  of  the  area  which  re- 
ceived the  thermic  impression  originally.  In  this  way  the 
circular  muscular  fibers  of  the  arterial  walls  are  made  to 
contract  .or  relax,  as  the  case  may  be.  In  addition  to  this 
reflex  process  the  application  of  heat  or  cold  to  the  skin  has 
a  purely  physical  effect,  consisting  in  the  contraction  or  ex- 
pansion of  the  contractile  tissues  of  the  skin,  especially  the 
muscular  fibers.  Hence,  there  necessarily  takes  place  a  con- 
traction or  dilatation  of  the  skin-capillaries  independently  of 
any  reflex  mechanism.  This  is  shown  by  applying  heat  or 
cold  to  the  skin  after  the  nerve-supply  has  been  rendered 
inert  (e.  g.  by  severing  the  nerve-fibers  supplying  the  re- 
gion). Thus,  the  phenomenon  known  as  cntis  anserina 
(goose-skin)  is  produced  by  purely  local  action  of  cold. 
The  non-striped  muscular  fibers  of  the  skin  and  of  the  ar- 
terial coats  violently  contract,  forcing  the  blood  out  of  the 
skin.  The  skin  looks  anemic,  sunken  and  wrinkled,  causing 
the  skin-papillae  to  appear  more  prominent  than  at  other 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.        91 

times.  Gradually  the  muscular  contraction  passes  off  and 
normal  conditions  are  re-established.  The  contracted  ves- 
sels are  gradually  rilled  with  blood,  which  rebounds  into 
them  with  renewed  vigor.  The  temporary  contraction  is 
followed  by  a  temporary  dilatation,  anemia  by  hyperemia. 
The  circular  fibers  of  the  arterial  walls  relax  beyond  their 
normal  size,  the  process  resembling  the  backward-swing- 
ing of  a  pendulum,  which  does  not  stop  at  the  central  point, 
but  swings  beyond  it.  This  peculiar  conduct  of  the  arterial 
walls  causing  a  hyperemic  condition  to  follov/  an  anemic 
state  produced  by  cold,  is  the  essence  of  what  hydro-thera- 
pists call  REACTION,  and  is  the  pivotal  point  upon  which  the 
science  of  hydro-therapy  revolves.  If  a  certain  area  of  skin 
is  rendered  anemic  by  the  action  of  cold,  the  blood  is  forced 
into  the  vessels  whence  the  blood-supply  of  that  particular 
area  of  skin  comes  (tributary  circulation).  Induced  ane- 
mia of  the  skin  is,  therefore,  necessarily  associated  with 
hyperemia  of  those  parts  into  which  the  blood  of  the  skin- 
vessels  has  been  forced.  When  the  action  of  cold  ceases, 
reaction  begins.  The  hyperemic  parts  unload  their  surplus 
of  blood  and  the  conditions  are  reversed :  the  subcutaneous 
tissues  become  comparatively  anemic  while  the  vessels  of 
the  skin  are  replete  with  blood.  The  intensity  of  reaction 
depends  upon  the  suddenness  with  which  the  cutaneous  ves- 
sels are  contracted,  and  upon  the  extent  of  the  area  within 
\vhich  anemia  is  produced.  If  the  reaction  involves  a  large 
area,  the  anemia  or  depletion  accompanying  it  may  affect 
deep  and  important  structures  at  some  distance  from  the 
hyperemic  area.  Thus,  it  has  been  practically  demonstrated 
(hat  forcible  reaction  involving  the  blood-supply  of  the  ab- 
dominal wall  will  affect  the  vessels  of  the  meninges.  Schuel- 
ler  trephined  rabbits  and  through  the  opening  made  ex- 
posed a  circumscribed  area  of  the  meninges.  Whenever  a 
c oW-water  application  was  made  to  the  abdomen  of  the  ani- 
mal, dilatation  of  the  vessels  of  the  pia  mater  was  distinctly 
noticeable  A  it'orw-water  application  to  the  abdomen  was 
followed  by  contraction  of  the  meningeal  vessels.  Immer- 


92  MODERN  PHYSIO-THERAPY. 

sion  of  the  animal  in  cold  water  was  promptly  followed  by 
wide  dilatation  of  the  meningeal  vessels,  immersion  in  hot 
water  caused  forcible  contraction.  Reaction  involving  the 
surface  of  the  extremities  and  the  trunk  (e.  g.  during  a  com- 
plete pack)  will  almost  deplete  the  encephalic  circulation,  as 
is  shown  by  the  somnolence  of  the  patient  during  the  pack. 

The  physiological  manner  in  which  reaction  takes  place 
is  still  a  matter  of  speculation.  Some  seem  to  think  that  the 
effect  (arterial  contraction)  passes  off  the  moment  the  cause 
(application  of  cold)  ceases  to  act.  "Cessante  causa  tollitur 
effectus."  Others  say  that  the  forcible  contraction  of  the 
muscular  coat  of  the  artery  temporarily  exhausts  the  tone 
of  the  vessel-wall  and  necessarily  leads  to  a  condition  of  re- 
laxation and  fatigue.  According  to  Winternitz,  however, 
reaction  is  a  more  complex  process.  He  states  that  the  ther- 
mic impulse  excites  the  vasomotors  and  thus  produces  con- 
traction of  the  artery.  Gradually  the  functional  potency  of 
the  vasomotors  is  exhausted,  exciting  the  inhibitory  nerves 
of  the  vessels  to  action,  thus  producing  vascular  relaxation. 

What  are  the  necessary  and  possible  physiological  results 
of  reaction  as  far  as  nutrition  generally  and  locally  is  con- 
cerned ?  In  considering  this  question,  we  must  distinguish 
between  the  area  to  which  the  thermic  stimulus  is  applied 
(primary  area)  and  the  area  which  is  rendered  anemic  by 
the  resulting  reaction  (secondary  area).  Thus,  if  we  apply 
A  cold,  moist  pack  (Priessnitz  method)  to  the  skin  of  the 
lower  extremities,  the  surface  packed  would  be  the  primary 
area.  When  reaction  sets  in,  the  primary  area  becomes  act- 
ively congested,  i.  e.  the  lower  extremities  become  replete 
with  blood.  It  stands  to  reason  that  as  the  blood-supply  in 
the  primary  area  increases,  some  other  part  or  parts  of  the 
body  must  lose  some  of  its  or  their  blood  in  order  to  make 
an  over-supply  in  the  primary  area  possible.  The  part 
which  yields  some  of  its  blood-supply  is  as  it  were  the  tribu- 
tary territory.  It  is  what  I  have  previously  designated  as 
the  secondary  area.  The  necessary  effect  of  a  reaction  in 
the  primary  area  is  a  partial  depletion  in  the  secondary 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.        93 

area.  This  is  a  simple  mechanical  problem.  To  the  mind 
of  the  intelligent  practitioner  there  is  contained  in  it  a 
wealth  of  therapeutic  suggestion.  If  the  secondary  area  is 
the  seat  of  a  pathological  (active  or  passive)  hyperemia^  it 
is  plain  that  partial  depletion  of  the  congested  part  means 
lessening  of  the  hyperemia  existing  there.  An  inflamma- 
tion would  necessarily  be  aborted  thereby  because  the  in- 
flammatory process  would  be  deprived  of  its  working  cap- 
ital. The  congested  area  is  partly  depleted  and  thus  de- 
prived of  the  essential  elements  of  inflammation.3  If  we 
apply  the  therapeutic  indications  of  Schueller's  experiments 
clinically  in  a  case,  for  instance,  of  simple  meningitis,  we 
are  clearly  conscious  of  the  modus  opcrandi  of  our  method. 
We  know  that  a  hydro-therapeutic  reaction  is  the  ideal  anti- 
phlogistic. It  is  venesection  without  loss  of  blood.  Thus 
we  are  in  a  position  to  summarize  the  broad  therapeutic 
availability  of  reaction  by  saying  that  the  production  of  re- 
action is  indicated  whenever  depletion  is  desirable.  It  is — 
cateris  paribns — the  scientific  remedy  for  the  relief  and 
cure  of  all  inflammatory  and  congestive  conditions.  We  can 
conscientiously  go  even  farther  and  say :  it  is  the  prophy- 
lactic measure  which  prevents  and  aborts  inflammation  and 
congestion.  Clinically  the  brilliant  statistics  of  pneumonia 


3The  hydro-therapeutic  "derivating"  method  is  the  classical 
type  of  a  rational  antiphlogistic  procedure.  The  principle  is  practi- 
cally the  same  as  is  contained  in  Priessnitz's  "refrigeration"  and 
Bier's  "congestive  method."  Priessnitz,  in  the  treatment  of  local- 
ized inflammations  in  the  extremities,  especially  in  joints,  frequently 
succeeded  in  aborting  the  inflammatory  action  by  continued  cold 
applications  above  the  seat  of  trouble  to  "cool  the  blood,"  and  in- 
cidentally, by  contracting  the  vessels,  to  lessen  the  blood  supply. 
Bier's  method  consists  in  applying  a  constricting  bandage  above 
the  seat  of  inflammation,  thus  causing  a  condition  of  stasis  below 
the  line  of  construction.  The  inflammation  is  literally  starved  out. 
Even  in  septic  inflammations  Bier's  method  is  of  service,  principally 
through  constriction  of  the  lymphatics  and  prevention  of  the  ab- 
sorption of  toxins.  Bier's  "congestive  method"  is  an  effective  ano- 
dyne, the  pain-relieving  effect  being  due  to  the  lessening  of  blood- 
pressure. 


94  MODERN  PHYSIO-THERAPY. 

treated  hydro-therapeutically  fully  bear  out  and  confirm 
these  statements.  It  is  plain  that  reaction  is  the  pivot  upon 
which  the  whole  practice  of  hydro-therapy  revolves.  Hydro- 
therapeutic  science  draws  its  clinical  conclusions  and  makes 
its  therapeutic  applications,  not  from  primary,  but  from 
the  secondary  effects.  Between  the  two  effects  reaction  is 
interposed  as  a  necessary  link  in  the  chain.  \Ye  are  ready 
to  understand  the  difference  between  hydro-therapy  and 
the  clinical  uses  of  superheated  air  (baking).  The  latter 
does  not  include  the  characteristic  "reaction"  in  its  modus 
operandi.  The  vessels  of  the  surface  are  dilated  at  once  by 
the  action  of  heat  and  are  kept  in  a  state  of  dilatation  by  the 
continued  and  enforced  application  of  heat.  Therein  lies 
the  therapeutic  rationale  of  superheated  air  applications. 
They  are  indicated  ( i )  in  all  conditions  in  which  "reaction" 
can  not  be  brought  about  or  only  imperfectly ;  (2)  in  cases 
where  the  production  of  primary  anemia  might  cause  aggra- 
vation of  some  congested  state  within  the  body;  and  (3)  in 
cases  where  the  condition  of  the  vessel-walls  would  centra- 
indicate  the  violence  of  a  reactive  process. 

What  has  been  said  before  expresses  in  a  general  way 
the  broad  principles  according  to  which  the  hydro-therapist 
proceeds  at  the  bedside.  The  strength  of  his  method  lies  in 
the  control  which  he  is  capable  of  exercising  over  circula- 
tion, and  in  this  way  over  (general  or  local)  nutrition.  Even 
the  mere  emptying  and  refilling  of  the  blood-vessels  of  a 
certain  portion  of  the  circulatory  system  affects  nutrition  in 
a  manner  most  striking.  Passively  hyperemic  organs  are  in 
this  way  unloaded,  the  healthy  tone  of  the  organs  is  re- 
established, the  tissue-change  within  the  organs  is  stimu- 
lated by  acceleration  and  regeneration  of  the  blood-current, 
products  of  decomposition  and  other  morbid  processes  are 
washed  away,  retrograde  metamorphosis  is  prevented. 
There  can  be  no  question  that  the  employment  of  so  pow- 
erful an  agent  presupposes  familiarity  with  the  condition  of 
the  organism  at  large,  and  sometimes  even  more  than  ordi- 
nary finesse  of  judgment.  Calcareous  vessel-walls,  an  apo- 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.        95 

plectic  condition,  luetic  changes  in  the  brain  or  spinal  cord, 
congestive  conditions  of  the  kidneys,  etc.,  are  for  obvious 
reasons  centra-indications  to  the  employment  of  heroic 
hydro-therapeutic  measures.  The  dry-heat  cylinder  or  the 
electric-light  bath  would  in  these  conditions  be  better 
adapted,  although  their  use  should  never  be  haphazard  or 
become  a  matter  of  routine.  On  general  principles,  how- 
ever, it  is  easier  to  be  successful  in  the  use  of  the  dry-heat 
cylinder  and  electric-light  bath  than  in  the  employment  of 
cold  water.  The  latter  requires  more  knowledge,  better 
judgment  and  some  experience.  It  is  the  more  powerful 
and  more  effective  agent. 

The  marvelous  effect  of  thermic  stimuli  upon  regions  at 
some  distance  from  the  seat  of  application  has  been  prac- 
tically shown  by  experiments  on  man  and  beast.  I  have  al- 
ready referred  to  Schueller's  experiments  on  rabbits.  The 
fact  that  not  only  the  meningeal  but  the  entire  intra-cere- 
bral  circulation  is  affected  by  the  thermic  stimuli,  was  shown 
by  a  plainly  noticeable  contraction  and  expansion  of  the 
brain-mass  itself.  Winternitz,  who  has  done  more  than  any 
other  investigator  to  define  the  physiological  laws  govern- 
ing the  effects  of  thermic  stimuli,  proved  that  during  a  warm 
sitz-bath  the  circumference  of  the  arm  decreased,  while  it 
increased  during  a  cold  sitz-bath.  His  observations  con- 
cerning the  effects  of  the  thermic  stimuli  on  the  central  or- 
gan of  circulation,  the  heart,  and  also  on  the  centers  of  respi- 
ration are  most  interesting.  The  decided  effects  of  cold 
upon  the  local  circulation  are  well  shown  by  Winternitz, 
who  made  sphygmographic  tracings  of  the  radial  artery  be- 
fore and  after  ice-applications  to  the  brachial  artery. 

It  has  been  stated  that  reaction  is  the  process  through 
which  hydro-therapy  accomplishes  its  great  results.  When- 
ever the  primary  thermic  stimulus  ceases  to  act  or  whenever 
a  stimulus  of  the  opposite  character  is  substituted,  reaction 
will  take  place.  To  explain:  If  we  envelop  a  patient  in  a 
cold,  moist  sheet  and  place  a  woolen  blanket  over  the  sheet 
fPriessnitz  pack),  the  action  of  the  sheet  will  be  of  but 


96  MODERN  PHYSIO-THERAPY. 

short  duration.  In  a  brief  space  of  time  the  normal  body- 
heat  supplemented  by  the  woolen  blanket  will  change  the 
cold  moist  sheet  to  a  warm  moist  sheet.  The  spaces  be- 
tween the  skin  and  the  sheet  and  between  the  sheet  and  the 
blanket  are  filled  with  a  warm  vapor,  which  acts  as  a  thermic 
stimulus  opposite  in  character  to  the  thermic  stimulus  rep- 
resented by  the  cold  moist  sheet.  What  takes  place  in  and 
beneath  the  skin  in  response  to  the  new  stimulus  is  what  we 
call  reaction.  Reaction  must  take  place  if  we  wish  to  ac- 
complish results  and  wish  to  prevent  harm  from  being  done. 
If  reaction  did  not  take  place,  the  result  would  be  conges- 
tions within  the  organism.  Perhaps  the  patient's  lungs  or 
bronchial  tubes  would  remain  congested.  In  the  language 
of  the  people,  the  patient  has  caught  a  cold.  By  a  cold  is 
meant  a  condition  characterized  by  congestion  of  one  or 
more  internal  organs  or  structures  and  produced  by  the 
action  of  low  temperature  on  (i.  e.  chilling  of)  the  skin. 
A  cold,  hydro-therapeutically  speaking,  is  the  result  when- 
ever reaction  is  imperfect  or  absent.  It  must  be  our  aim 
to  produce  reaction  at  all  hazards.  If  there  is  a  lack  of 
tonicity  in  the  arterial  walls,  causing  the  circulation  to  be 
sluggish  and  nutrition  to  be  bad,  we  must  augment  the 
hydro-therapeutic  procedure  by  other  means.  Friction  and 
massage  of  the  body-surface  might  be  required  to  bring  on 
reaction.  The  question  of  reaction  again  calls  for  nicety  of 
judgment  entirely  inseparable  from  accurate  physiological 
knowledge  and  from  the  ability  to  individualize  cases.  We 
are  again  prepared  to  admit  that  the  successful  hydro-thera- 
pist must  needs  be  a  scientific  physician. 

It  is  of  some  importance  to  know  the  effect  of  a  cold  or  a 
hot  water  application  upon  the  body-temperature,  or  upon 
the  temperature  of  any  part  of  the  body  if  only  a  partial  ap- 
plication be  made.  We  know  that  the  self-consumption  of 
the  body  is  a  process  of  combustion  accompanied  by  a  cer- 
tain degree  of  heat.  The  relative  rapidity  with  which  the 
body  is  burnt  up  and  the  amount  of  heat  produced  are  in  di- 
rect proportion.  If  combustion  takes  place  more  rapidly 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.        97 

than  the  normal  physiological  process  of  self-consumption, 
the  process  is  called  fever,  and  is  accompanied  by  a  corre- 
sponding rise  of  the  ordinary  heat  of  combustion.  It  is  a 
well-established  fact  that  the  physiological  heat  of  the  body 
is  maintained  by  certain  automatic  safety-apparatus,  which 
equalize  the  contrast  between  the  temperature  within  and 
that  outside  of  the  body.  High  temperature  applied  to  the 
whole  body-surface  will  necessarily  cause  a  rise  of  the  tem- 
perature within  the  body.  The  organism  at  once  makes  an 
effort  to  get  rid  of  the  surplus  heat  through  the  activity  of 
the  sweat-glands,  the  process  of  expulsion  of  surplus  body- 
heat  being  known  as  "diaphoresis."  If  a  very  low  tem- 
perature acts  upon  the  surface  of  the  body,  the  temperature 
within  the  organism  will  of  course  sink.  The  organism, 
however,  makes  a  prompt  effort  to  supply  an  additional 
amount  of  heat  by  causing  the  animal-economy  to  consume 
itself  more  rapidly.  Metamorphosis  of  matter  and  heat- 
production  are  always  in  proportion.  Therefore,  fever 
means  over-consumption.  Its  objective  evidence  is  elevated 
temperature.  Physiologically,  fever  is  an  attempt  on  the 
part  of  nature  to  regenerate  the  body,  to  burn  up  morbid 
material,  to  make  new  and  healthy  tissue.  Fever,  there- 
fore, is  a  salutary,  curative  effort ;  it  is  the  ally  of  dis- 
ease. The  organism  which  is  constantly  regenerating  itself, 
is  doing  so  with  increased  vigor  when  fever  supervenes. 
The  surface  of  the  body  is  studded  with  innumerable  little 
openings  through  which  gases  and  vapors  constantly  es- 
cape. When  the  excreted  material  is  so  copious  that  it  can 
not  all  evaporate  through  the  skin,  it  escapes  in  liquid  form 
(sweat).  It  is  clear  what  a  close  physiological  relationship 
exists  between  fever  and  perspiration  and  what  valuable 
therapeutic  lessons  can  be  learned  from  the  knowledge  of 
this  relationship.  The  treatment  of  a  febrile  condition  or — 
to  speak  more  correctly — an  attempt  to  aid  nature  in  her 
efforts  to  save  the  organism  from  the  ravages  of  disease, 
imperatively  calls  for  close  attention  to  the  excretory  func- 
tion of  the  skin.  If  there  is  little  or  no  attempt  to  perspire, 


98  MODERN   I'JIYSIO-TIIKKAPY. 

<u;.phoresis  should  be  brought  about  by  hydro-therapeutic 
means.  Reaction  implies  active  hyperemia  of  the  skin,  act- 
ive hyperemia  is  synonymous  with  over-nutrition,  over- 
imtrition  means  increased  functional  activity.  By  regu- 
lating circulation  we  control  nutrition  and  functional  act- 
ivity. Truly  unlimited  therapeutic  resources  are  contained 
in  this  simple  but  momentous  statement ;  for  it  holds  good, 
not  only  in  regard  to  the  skin,  but  pertains  to  every  func- 
tionating structure  in  the  body.  Granting  that  we  can  con- 
trol circulation,  it  must  be  admitted  that  we  can  at  will 
regulate  nutrition  and  function  locally  and  generally.  We 
can  produce  sleep  by  hydro-therapeutic  reaction  causing 
cerebral  anemia  (Priessnitz  pack  of  the  body)  ;  we  can 
unload  the  portal  circulation,  and  thus  rslieve  a  congested 
liver  (pack  of  the  abdomen  and  the  lower  extremities)  ;  we 
can  promptly  check  hemoptysis  by  rendering  the  lungs 
anemic  (pack  of  the  lower  extremities),  etc.,  etc.,  ad  in- 
•finitum.  We  can — last  but  not  least — help  nature  in  its 
febrile  efforts  by  stimulating  tissue-change  and  aiding 
cutaneous  excretion,  while  by  well-directed  thermic  efforts 
the  distressing  companion  of  fever,  namely  high  tempera- 
ture, is  held  at  bay. 

Diaphoresis,  however,  means  more  than  simple  excre- 
tion. Just  as  the  organism  automatically  equalizes  the  nor- 
mal heat  of  the  body,  it  likewise  maintains  the  physiolog- 
ical equilibrium  of  aqueous  elements  within  the  body.  This 
explains  the  primary  effect  of  diaphoretic  action.  As  the 
aqueous  elements  escape  through  the  skin,  the  total  amount 
of  watery  elements  within  the  body  necessarily  diminishes. 
The  blood  becomes  partly  dehydrated,  rendering  it  thicker. 
Nature  makes  an  effort  to  restore  the  proportion  of  blood- 
serum  by  drawing  upon  the  physiological  and  pathological 
liquids  present  in  the  tissues.  In  this  way  diaphoresis  pro- 
duces absorption,  another  of  Nature's  great  curative  factors. 

Purely  reflex  effects  which  may  be  produced  by  the  ac- 
tion of  a  local  thermic  stimulus,  e.  g.  a  cold  douche  applied 
to  the  back,  are  physiologically  interesting  and  clinically  of 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.        99. 

importance.  Through  the  sympathetic  nervous  system  the 
impression  made  upon  the  cutaneous  nerves  reverberates 
throughout  the  ramifications  of  the  sympathetic  and  ex- 
plodes at  some  point  or  points  of  selection,  the  latter  being 
dependent  upon  circumstances  that  are  not  always  within 
our  sphere  of  physiological  calculation.  The  skin  responds 
with  striking  readiness  to  stimuli  of  this  kind  as  well  as  to 
any  kind  of  sudden  impressions,  even  psychic  in  character. 
This  is  the  physiology  of  the  cut  is  anscrina  (goose-skin). 
Being  closely  associated  with  the  mechanism  of  respiration 
the  skin  communicates  its  stimuli  to  the  respiratory  centers 
and  indirectly  to  the  heart.  A  sudden  cold  douche  may  in 
this  way  seriously  react  upon  respiration  and  circulation  by 
overstimulation  and  resulting  exhaustion  of  the  nerve-sup- 
ply of  the  lungs  and  heart.  In  the  same  way  the  effect  of  a 
very  cold  drink,  especially  while  the  organism  is  function- 
ally very  active  (in  hot  weather),  might  be  disastrous,  the 
thermic  stimulus  being  communicated  to  the  general  sys- 
tem through  the  nerves  and  sympathetic  ganglia  of  the 
stomach.  Every  one  is  familiar  with  the  immediate  effect  of 
a  sudden  cold  douche :  chilling  of  the  body-surface,  deep 
breathing  and  violent  heart's  action.  Thermic  stimuli  that 
are  not  sudden  and  violent,  are  not  per  se  productive  of 
characteristic  reflex  effects. 

Clinical  Considerations. 

From  the  theoretical  points  evolved  it  is  evident  that 
applications  of  heat  and  cold  are  capable  of  affecting  the 
whole  organism  in  any  and  all  its  functions.  The  effects 
produced  are  either  stimulating  (increasing  the  active  cir- 
culation in  a  part,  intensifying  metabolism,  augmenting 
every  manifestation  of  vitality  in  the  part),  or  sedative 
(decreasing  the  active  circulation  in  a  part,  retarding  meta- 
bolism, depressing  every  manifestation  of  vitality  in  the 
part).  If  cold  water  is  used,  the  secondary  effect  is  in  real- 
ity the  therapeutic  effect,  the  primary  action  being  tem- 
porary and  only  preparatory.  A  typical  example  of  "reac- 


100  MODERN  PHYSIO-THERAPY. 

lion"  is  the  erection  which  follows  the  use  of  the  cold  sound. 
In  warm  or  hot  applications  of  any  kind  there  is  no  prepara- 
tory effect.  The  therapeutic  effect  is  immediate  and  takes 
place  without  a  preceding  reaction.  A  continuous  cold  ap- 
plication would,  of  course,  retard  or  perhaps  prevent  reac- 
tion by  exhausting  the  responsive  power  of  the  vaso-motors. 
The  therapeutic  indications  are  plainly  suggested  by  the  fol- 
lowing general  summary  of  thermic  effects : 

1.  Short  applications  of  extreme  heat  or  intense  cold 
(thermic   shocks)    are   markedly   stimulating  even   to   the 
point  of  intense  excitation.    The  action  of  cold  is  more  pro- 
found than  that  of  heat.    This  is  what  makes  cold  applica- 
tions of  short  duration  and  repeated  at  regular  intervals 
(e.  g.  every  day)  a  powerful  tonic. 

2.  Applications  of  moderate  heat  are  moderately  seda- 
tive.    A  prolonged  application  of  this  kind  exhausts  the 
functional  tone  of  the  cutaneous  and  sympathetic  nerves 
and  is,  therefore,  depressing. 

3.  Applications  of  moderate  cold  are  slightly  stimulat- 
ing.    They  become  less  so,  the  longer  they  are  continued, 
although  they  are  not  depressing. 

4.  Applications  of  intense  heat,  if  continued  for  a  long 
time,  are  stimulating  as  long  as  the  skin  activity  is  not  too 
pronounced.     Profuse  perspiration  is  distinctly  depressant, 
although  this  effect  usually  passes  off  very  quickly. 

5.  Applications  of  cold,  if  continued  for  a  long  time, 
depress  the  organism  even  to  the  point  of  collapse  and  death. 
Cases  of  sunstroke  sometimes  succumb  to  the  irrational  use 
of  cold  water  and  ice,  en  vogue  in  some  of  our  public  hos- 
pitals. 

6.  Indifferent  temperature    (e.   g.   a  bath   at  9O°-ioo0 
Fahrenheit)    produces  neither  stimulation  nor  depression. 
It  is  sedative  because  it  obtunds  the  responsive  power  of 
the  skin-nerves  mechanically. 

Translating  the  physiological  effects  included  under 
these  six  headings  into  therapeutic  indications,  the  classifica- 
tion would  read  something  like  this : 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.       101 

1.  Intense  stimulation  by  short  applications  of  heat  or 
cold  is  indicated  in  conditions  of  extreme  exhaustion,  col- 
lapse and  shock,  surgical  and  otherwise,  sudden  heart-weak- 
ness due  to  heart-disease  or  the  action  of  an  anaesthetic, 
drowning,    syncope,    suffocation,   psychic    impressions   and 
any  condition  in  which  there  is  a  sudden  failure  on  the  part 
of  the  circulatory  apparatus.     Frequently  it  is  of  advantage 
to  alternate  the  hot  and  cold  stimuli. 

2.  Moderate  heat  is  an  excellent  sedative  in  cases  of  ac- 
centuated reflexes,  in  all   forms  of  neuroses,   in  hysteria, 
nervous  irritability  and  overstimulation. 

3.  Moderate  cold  is  a  useful  stimulant  in  all  continued 
fevers  and  weakness  produced  by  any  cause.     If  the  circu- 
lation is  sluggish,  the  reflexes  retarded  and  the  vitality  of 
the  whole  organism  below  par,  stimulation  of  this  kind  is 
indicated. 

4.  Long-continued  applications  of  intense  heat  increase 
the  metabolic  activity  of  the  organism  and  produce  a  won- 
derfully alterant  effect.     Excretion  and  absorption  become 
much  more  active.    This  is  capital  treatment  in  all  forms  of 
gout  and  rheumatism,  Bright's  disease,  inflammations  of  the 
joints,  bruises,  sprains  and  many  more  conditions  too  nu- 
merous to  mention.   The  "baking"  process  is  an  illustration 
of  this  form  of  therapy. 

5.  Applications  of  cold  of  long  duration  are  never  thera- 
peutically  indicated.     They  should  be  discontinued  the  mo- 
ment local  or  general  depression  becomes  manifest.     Cold 
applications  possess  excellent  stimulating  and  antiphlogistic 
properties  and  should  not  be  carried  to  the  point  of  de- 
pression.   The  ice-bag  is  a  splendid  but  much  abused  agent. 
Continuous  applications  of  ice  to  an  injured  or  inflamed 
joint,  for  instance,  are  absurd.     The  effect  is  a  suspension 
of  the  vital  forces  and  such  treatment  is  the  worst  kind  of 
meddlesome  interference  with  nature's  reparatory  efforts. 
A  short  cold  application,  followed  by  continued  hot  appli- 
cation, is  splendid,  especially  in  the  treatment  of  conditions 
in  which  "baking"  is  indicated.     The  preceding  cold  appli- 


102  MODERN  PHYSIO-THKK.U-*  . 

cation,  by  its  powerful  stimulating  action,  intensifies  the 
effect  of  heat. 

6.  Indifferent  temperatures  have  no  special  therapeutic 
significance  beyond  the  slightly  sedative  action  which  they 
produce. 

All  these  effects  are  physiological.  The  purely  physical 
action  of  intense  heat  and  cold  is  seen  in  the  stoppage  of 
hemorrhage  by  direct  application.  It  stands  to  reason  that 
the  mucous  membranes  of  the  mouth,  stomach,  rectum  and 
vagina  can  be  acted  upon  analogously  to  the  skin.  The 
swallowing  of  small  pieces  of  ice  is  useful  in  cases  of  gastric 
bleeding.  The  hot  vaginal  douche  enjoys  a  well-merited 
reputation  as  a  restorer  of  the  local  circulation  and  a  stimu- 
lant of  great  virtue.  A  cold  water  injection  into  the  rectum 
is  a  powerful  stimulant  which  affects  the  whole  system.  It 
is  useful  in  cases  of  exaggerated  reflexes,  especially  acute 
hysteria.  It  is  plain  that  all  these  effects  can  be  intensified 
by  the  addition  of  light  and  of  suitable  massage,  vibration, 
etc. 

The  technique  of  applying  heat  and  cold  has  everything 
to  do  with  the  therapeutic  effect.  For  the  sake  of  con- 
venient classification  we  may  divide  the  applications  into 
such  as  produce  a  secondary  effect  after  a  preparatory  pri- 
mary action  has  passed  off  (reactive  applications),  c.  g.  the 
cold  douche,  which  contracts  the  cutaneous  vessels,  in  order 
to  bring  about  a  powerful  secondary  hyperemia  of  the  skin. 
Then  there  are  those  modes  of  application  whose  virtue  de- 
pends upon  the  production  of  a  lasting  primary  effect  (non- 
reactive  applications),  e.  g.  the  use  of  superheated  air, 
which  aims  at  a  dilatation  of  the  cutaneous  vessels  and  pro- 
duces this  effect  directly.  The  continuous  applications  of 
cold  and  heat  are  distinctly  non-reactive. 

The  reactive  applications  are: 

The  moist  pack  (local  or  general).  In  justice  to  its 
originator  it  ought  to  be.  known  as  the  Priessnitz  pack.  It 
consists  of  a  cold  wet  cloth,  over  which  dry  pieces  of  woolen 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.       103 

material  are  placed.  The  size  and  the  manner  of  packing 
will,  of  course,  depend  upon  the  part  of  the  body  to  which 
it  is  applied.  The  action  of  the  moist  pack  is  as  follows: 
The  cold  moisture  of  the  sheet  causes  contraction  of  the 
cutaneous  vessels.  The  blood  is  forced  into  the  vessels  of 
the  contiguous  structures,  causing  an  acute  hyperemia. 
Soon,  however,  the  reaction  sets  in,  forcing  the  blood  back 
into  the  cutaneous  vessels,  which,  as  a  result,  dilate.  By 
this  time  the  normal  temperature  of  the  body,  aided  by  the 
heat-retaining  dry  woolen  covering,  has  warmed  up  the 
moisture  of  the  linen  sheet.  The  pack  keeps  the  skin  hot, 
and  in  this  way  intensifies  and  continues  the  reaction.  An 
enormous  amount  of  blood  is  drawn  to  the  surface,  leaving 
the  deeper  structures  partially  depleted.  The  therapeutic 
value  of  the  moist  pack  will  readily  be  seen.  Every  physi- 
cian knows  its  value  in  cases  of  sore  throat,  tonsillitis,  etc., 
in  which  the  pack  is  applied  to  the  neck.  If  applied  to  both 
lower  extremities,  a  relative  anemia  of  the  trunk  and  head  is 
the  result.  If  applied  to  the  abdomen,  partial  depletion  of 
the  abdominal  vessels,  especially  the  sluggish  portal  system, 
will  follow.  If  any  limited  part  of  the  body-surface  is 
packed,  the  result  will  invariably  be  an  anemia  of  the  part 
or  parts  whence  the  blood-supply  of  the  packed  area  comes. 
This  form  of  treatment,  by  which  blood  is  taken  away  from 
one  part  and  drawn  to  a  distant  part,  is  called  "derivating 
method"  (ableitendes  Verfahren}.  It  accomplishes  in  con- 
gestions and  inflammatory  conditions  what  venesection  aims 
at,  without,  however  weakening  the  organism  by  loss  of 
blood.  As  a  result  of  the  anemia  produced,  the  nutrition  of 
the  depleted  part  or  organ  will  necessarily  be  affected.  Cir- 
culation is  eventually  stimulated,  tissue-change  accelerated, 
absorption  promoted.  Thus  we  may  look  upon  the  Priess- 
nitz  pack  as  an  alterative  of  great  virtue.  The  duration  of 
a  pack  depends  upon  the  peculiarities  of  each  case,  and 
varies  from  one  to  three  hours.  It  has,  as  will  be  readily 
seen,  a  wide  range  of  applicability.  It  is  useful  in  all  cases 
of  inflammation,  where  its  powerful  effect  upon  the  circula- 


104  MODERN  PHYSIO-THERAPY. 

tion  makes  it  a  true  antiphlogistic.  Congestive  headache, 
insomnia,  abdominal  plethora,  hemoptysis  and  a  host  of 
other  conditions  can  be  treated  according  to  the  "derivat- 
ing"  method  with  a  great  deal  of  benefit.  Cases,  of  course, 
should  be  individualized.  The  physician  should  employ  the 
method  in  keeping  with  its  physiological  effect.  '  The  indis- 
criminate employment  of  so  powerful  a  reagent  is  not  with- 
out danger.  For  obvious  reasons,  organic  disease  of  the 
heart  and  degenerative  changes  in  the  arterial  walls  (leutic, 
calcerous,  etc.)  are  centra-indications.  The  cold  moist 
pack  is  probably  the  best  and  most  easily  administered  hy- 
driatic  application.  Applied  to  the  whole  body  it  is  known 
as  the  general  pack  (popularly  called  "the  Spanish  mantle"). 
Two  or  three  woolen  blankets  are  spread  on  a  bed.  Over 
them  a  sheet  wrung  out  in  cold  water  Is  placed.  The  patient 
lies  down  upon  this  sheet  and  is  quickly  wrapt  in  (i)  the 
sheet,  care  being  taken  to  wrap  all  the  extremities  separately 
and  to  make  the  sheet  fit  snugly;  and  (2)  in  the  woolen 
blankets,  which  are  wrapt  over  the  wet  sheet.  The  head  of 
the  patient  is  not  included,  a  dry  towel  being  tucked  in  be- 
low the  chin  and  on  both  sides  of  the  neck,  to  prevent  the 
air  from  striking  the  wet  sheet.  The  duration  of  the  pack 
depends  on  circumstances.  If  the  patient  stands  the  pack 
well,  it  should  not  be  removed  until  he  has  ceased  to  sweat 
and  is  beginning  to  complain  of  a  clammy  feeling.  Then 
the  pack  is  removed  and  the  patient  is  given  a  brisk  cold 
rub-down.  The  general  pack  is  indicated  in  all  conditions 
in  which  depletion  of  the  brain  is  desired  (insomnia,  in- 
flammatory conditions  of  the  brain,  apoplexy,  etc.).  As  a 
general  tonic  to  stimulate  metabolism  and  increase  skin- 
function  it  is  unexcelled.  It  is  a  powerful  antipyretic  in  con- 
tinued fevers.  In  diphtheria  and  all  conditions  characterized 
by  angina  it  is  a  valuable  adjunct.  In  internal  congestions 
(lungs,  bowels,  liver),  accompanied  by  imperfect  excretion, 
the  general  pack  renders  signal  service.  In  all  conditions 
of  auto-intoxication  it  is  indicated.  For  tonic  purposes  it 
may  be  given  once  or  twice  a  week,  as  an  alterant  every  day, 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.       105 

£is  an  antipyretic  several  times  daily,  depending  on  the  re- 
quirements of  the  case.  The  average  duration  of  a  pack  is 
one  hour. 

A  partial  cold  moist  pack  may  be  applied  to  the  body 
from  the  feet  to  the  nipple  (leaving  the  arms  out),  to  the 
lower  costal  border,  to  the  umbilicus,  to  the  hips  to  effect 
depletion  above  the  packed  area.  In  bleeding  from  and  in- 
flammation or  congestion  of  the  lungs  (hemoptysis,  pneu- 
monia) these  partial  packs  are  very  useful.  A  cold  moist 
pack  to  the  shoulders  and  chest  (hydriatic  shawl,  cross- 
binder)  is  serviceable  to  relieve  cough,  to  deplete  congested 
parts  in  the  chest,  to  force  the  absorption  of  pleural  exu- 
dates.  An  abdominal  pack  is  indicated  in  intra-abdominal 
congestions  (peritonitis,  intestinal  inflammation,  appendi- 
citis, peritoneal  exudates).  It  has  been  demonstrated  that 
about  one-third  of  the  blood-mass  of  the  whole  body  can  be 
assembled  in  the  abdominal  wall  by  a  pack  of  this  kind.  All 
these  partial  applications  deplete  the  brain  more  or  less  and 
produce  sleep.  Localized  applications  may  be  made  to  any 
portion  of  the  body  to  produce  a  derivating  effect  in  some 
inflamed,  congested  or  inactive  region  at  some  distance 
away. 

The  cold  douche  is  a  powerful  reactive  water-applica- 
tion. It  may  be  general  or  partial.  It  may  be  administered 
in  the  form  of  a  fine  spray,  a  coarse  affusion  or  a  solid 
stream.  It  may  strike  the  body-surface  with  considerable 
force  or  gently.  All  these  factors  affect  the  therapeutic  re- 
sult, which  consists  in  a  powerful  stimulation  of  the  area 
treated,  increased  circulation  and  coincident  derivation  from 
the  tributary  area.  It  can  be  administered  by  means  of  elab- 
orate modern  devices  or  by  means  of  more  primitive  ap- 
pliances, e.  g.  the  sprinkling-can,  which,  through  the  adher- 
ents of  Father  Kneipp,  has  risen  to  the  level  of  an  impor- 
tant therapeutic  auxiliary.  A  preceding  hot  application  en- 
hances the  stimulating  effect.  The  impact  of  the  impinging 
water  stimulates  the  cutaneous  nerves.  The  tonic  stimu- 
lating effect  decreases  in  proportion  to  the  length  of  time 


106  MODERN  PHYSIO-THERAPY. 

and  the  temperature  of  the  water.  The  application  should 
be  short  (one-half  minute  to  one  minute).  The  water 
should  have  a  temperature  of  about  50°  F. 

The  longer  the  duration  and  the  warmer  the  water,  the 
less  marked  is  the  stimulating  effect.  Doucjies  may  be  used 
after  warm  applications  to  cool  the  surface.  They  are  in- 
dicated in  all  cases  requiring  local  or  general  stimulation : 
neurasthenia,  especially  sexual  (douche  of  the  spine),  mus- 
cular atony,  obtunded  reflexes,  debility.  To  arouse  and  mod- 
ify vitality  of  the  nerves  in  paralytic  and  neuralgic  condi- 
tions the  douche  is  very  useful. 

The  cold  rub,  either  in  the  form  of  a  sponge-bath  or  ad- 
ministered by  rubbing  or  slapping  the  patient's  skin  through 
a  wet  sheet  in  which  he  is  wrapt,  is  an  excellent  antipyretic 
fin  the  conditional  sense  set  forth  previously)  and  indicated 
in  febrile  states  generally.  Its  therapeutic  indications  are 
mainly  stimulation  and  derivation  in  conditions  of  faulty 
metabolism,  congestion,  sluggish  circulation,  etc.  It  may 
be  applied  generally  or  locally. 

The  cold  immersion  (full  bath,  half  bath,  plunge,  sitz- 
bath,  partial  immersion)  is  given  in  tubs  of  different  shapes 
and  sizes.  The  physiological  effect  is  identical  with  that  of 
the  other  methods  of  using  cold  water :  stimulation,  deriva- 
tion, antipyresis.  If  these  baths  are  too  long  continued, 
reaction  may  not  set  in  or  only  incompletely,  causing  de- 
pression. Baths  of  this  kind  (temperature  5o°-6o0  F.) 
should  last  from  two  to  ten  minutes.  In  the  plunge-bath  the 
patient  is  actively  exercising  his  muscles,  keeping  the  body 
and  the  water  in  a  state  of  constant  agitation.  The  dura- 
tion of  all  cold  immersions  is  gauged  by  the  temperature  of 
the  water  and  by  the  extent  of  the  area  treated.  The  colder 
the  water  and  the  more  extensive  the  territory  treated,  the 
shorter  should  be  the  duration  of  the  bath. 

Walking  in  ivet  grass  or  newly  fallen  snow  is  done  for 
the  purpose  of  depleting  the  trunk  and  head.  It  is  a  very 
effective  agent  and  became  popular  through  the  followers 
of  Kneipp. 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.       107 

The  non-reactive  applications  are : 

Continuous  application  of  cold  water  (full  or  partial 
bath,  cold  compresses,  the  running-water  coil  for  the  head 
and  other  parts  of  the  body,  douches,  etc.)  have  no  well- 
marked  therapeutic  indications  unless  the  area  treated  is 
comparatively  small.  A  continuous  application  of  mod- 
erate cold  has  a  decided  antiphlogistic  effect  on  the  region 
treated  and  on  the  tributary  and  contiguous  territory.  The 
larger  the  area  treated,  the  more  marked  the  general  seda- 
tive an.l  depressing  effect.  These  applications  should  be 
used  discreetly  and  with  a  well-defined  object  in  view.  The 
area  should  be  limited  to  get  the  benefit  of  the  antiphlogistic 
action  of  the  continuous  application  of  cold.  A  cold  appli- 
cation to  the  abdomen  favors  the  accumulation  of  blood  in 
the  abdominal  cavity  and  promotes  functional  activity  of 
the  intra-abdominal  organs.  In  constipation,  in  sluggishness 
of  the  liver  and  intestines,  in  atonic  diarrhea,  etc.,  it  can 
be  employed  with  good  effect. 

Continuous  applications  of  hot  water  (full  or  partial 
hath,  hot  compresses,  douches,  etc.)  stimulate  the  region 
thus  treated  during  the  first  few  minutes,  after  which  the. 
effect  becomes  sedative,  relaxing  and  depressing,  depending 
on  the  extent  of  the  area  treated.  The  vessels  of  the  area 
treated  are  dilated  and  remain  so,  if  the  application  is  con- 
tinued. Thus,  the  tone  of  the  vessels  is  exhausted  and  the 
depressing  effect  follows.  Local  applications  of  this  kind 
have  an  antispasmodic,  relaxing  and  anodyne  action.  As 
a  preserver  of  vitality  continuous  applications  of  heat  fre- 
quently serve  an  excellent  purpose.  In  severe  contusions, 
especially  if  the  soft  parts  have  been  crushed  and  sloughing 
is  inevitable,  constant  immersion  of  the  part  in1  hot  water  is 
by  far  the  best  treatment.  The  old-fashioned  flaxseed  poul- 
tice is,  in  its  therapeutic  indications,  analogous  to  the  con- 
tinuous application  of  hot  water. 

The  rapor-bath  (steam-bath)  is  a  producer  of  copious 
diaphoresis.  Therein  lies  its  therapeutic  significance.  In 
most  fevers  and  organic  diseases  of  the  central  nervous  sys- 


108  MODERN  PHYSIO-THERAPY. 

tern  and  organic  diseases  of  the  heart  this  form  of  bath 
should  not  be  employed  without  great  caution.  It  is  useful 
as  an  adjunct  in  the  treatment  of  metabolic  disorders  and 
diseases  of  the  general  system  (syphilis,  obesity,  etc.). 

On  general  principles  the  hydriatic  methods  that  are 
non-reactive  are  therapeutically  inferior  to  those  which  in- 
volve the  characteristic  reaction.  The  latter  are  the  class- 
ical water  applications  which  made  the  great  empirics 
Priessnitz  and  Kneipp  famous.  Stimulation  of  the  vital 
forces  locally  or  generally  is  the  purpose  of  all  therapy  in 
most  chronic  diseases.  For  this  reason  the  use  of  reactive 
water-applications  is  our  sheet-anchor  in  the  treatment  of 
chronic  maladies.  If  we  try  to  understand  the  physiology  of 
the  effects  produced  by  the  action  of  cold  or  heat,  we  ought 
to  experience  no  difficulty  in  adapting  these  physiological 
means  to  our  therapeutic  ends.  Of  all  branches  of  practical 
medicine  hydro-therapy  is  the  purest  and  most  scientific. 
Water  is  the  most  useful  remedy  because  it  is  indicated  at 
all  times,  has  definite  action  and  can  be  used  in  an  endless 
\ariety  of  ways  for  an  unlimited  number  of  conditions. 
Compared  to  water  as  a  therapeutic  agent  drugs  dwindle 
into  insignificance.  No  drug  can  take  the  place  of  water, 
but  water  can  take  the  place  of  all  drugs  as  shown  by  the 
magnificent  clinical  record  established  by  hydriatists  from 
times  immemorial.  After  making  practical  use  of  hydro- 
therapy  in  a  variety  of  ways  and  realizing  its  almost  mirac- 
ulous therapeutic  possibilities,  we  will  be  prepared  to  agree 
with  Pindar  of  old  who  never  tired  of  extolling  the  virtues 
of  water  and  who  summarized  his  opinion  of  water  in  his 
immortal  epigram :  "Water  is  the  best  of  all !" 

The  Therapy  of  Dry  Heat. 

The  physiological  principles  which  govern  the  clinical 
uses  of  heat  are  included  in  the  discussion  of  thermic  stimuli. 
(See  HYDRO-THERAPY.)  The  depressing  effects  which 
follow  continuous  applications  of  heat  are  much  reduced  in 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.       109 

intensity  if  dry  heat  is  substituted  for  moist  heat,  i.  e.  if  air 
is  substituted  for  water  as  the  carrier  of  the  thermic  stim- 
ulus. Thus  the  application  can  be  continued  for  a  much 
longer  space  of  time  and  a  higher  degree  of  heat  employed. 
Owing  to  the  comparative  simplicity  of  technique,  the  .use 
of  dry  heat  has  become  very  general  and  enjoys  a  well- 
merited  degree  of  popularity. 

The  greatest  difference  between  intense  degrees  of  dry 
and  moist  heat  is  the  irritating  action  of  the  latter1  on  the 
skin  as  compared  to  the  mild  non-irritant  effect  of  the  for- 


A  THERMIC  TREATMENT  OF  THE  KNEE. 

mer.  This  difference  in  favor  of  dry  heat  makes  the  latter 
a  safer  agent  to  use.  Prolonged  applications  of  intense 
heat  have  at  first  markedly  stimulating  effects.  Soon  the 
evidences  of  overstimulation  become  apparent.  The  body- 
temperature  rises,  nerve-energy  is  depressed,  the  heart  be- 
comes weak,  respiration  is  correspondingly  rapid  and  super- 
ficial. The  system  is  overcharged  with  COs-  The  organism 
attempts  to  throw  off  heat  and  gaseous  waste-products  by 
accelerated  and  intensified  skin-function,  i.  e.  copious  dia- 
phoresis. Absorption  is  thus  promoted  and  metabolism 
stimulated.  The  demand  for  physiological  fuel  on  the  part 
of  the  system  frequently  manifests  itself  by  increased  ap- 


110  MODERN  PHYSIO-THERAPY. 

petite.     The  depression  usually  passes  off  the  moment  the 
thermic  stimulus  is  taken  off. 

The  fact  that  the  characteristic  violent  "reaction"  does 
not  take  place,  makes  a  general  application  of  dry  heat  a 
comparatively  safe  procedure  in  many  conditions  in  which 
a  cold  stimulus  followed  by  reaction  and  heat  (e.  g.  in  tlu- 
general  cold  moist  pack)  would  not  be  indicated.  This  is 
the  case  in  organic  disease  of  the  heart,  in  degenerations  of 
the  vessel-walls,  in  toxic  conditions  of  various  kinds  an  1 
in  inflammatory  and  catarrhal  states  of  the  kidneys.  In 
these  conditions  dry  heat  applied  in  a  properly  constructed 
cylinder  heated  by  gas,  alcohol  or  gasoline,  is  a  most  valua- 
ble therapeutic  agent  which  entails  no  danger  to  the  patient, 
if  ordinary  care  is  exercised  by  the  medical  attendant.  In 
rheumatism  the  effect  on  excretion  is  a  therapeutic  factor 
which  can  not  possibly  be  overestimated.  In  local  condi- 
tions, such  as  sprains,  contusions  and  rheumatic  joints,  dry 
heat  is  applied  directly  to  the  affected  area.  The  intense 
compensatory  effort  made  by  nature  after  the  excretion  and 
hyper-nutrition  which  have  followed  the  application  of  dry 
heat  ("baking"),  results  in  absorption  of  inflammatory 
products,  of  extravasated  blood  and  edematous  swellings 
and  in  a  powerful  impetus  to  the  reparative  work  of  nature. 
Pain  is  usually  relieved  very  promptly.  In  a  general  way 
it  is  fair  to  state  that  dry  heat  is  the  best  therapeutic  agent 
in  the  treatment  of  bruises,  sprains,  and  especially  rheuma- 
tism. The  statement  made  by  some  observers  that  the  ap- 
plication of  intense  dry  heat  to  inflamed  and  infected  areas, 
c  g.  in  cases  of  pneumonia,  results  in  a  heating  Up  of  in- 
flamed tissue  (e.  g.  hepatized  portions  of  lung-tissue)  and 
in  this  way  acts  as  a  direct  germicide,  is  theoretically  and 
practically  untenable.  It  is  erroneous, — (i)  because  the  ac- 
tion of  germicidal  heat  would  be  coincident  with  suspension 
of  vitality  and  destruction  of  organic  tissue  (Winternitz)  ; 
.(2)  because  intense  heat  would  seriously  interfere  with  the 
function  of  the  absorbent  and  blood-vessels  in  the  process 
of  repair;  and  (3)  because  intense  heat  has  a  tendency  to 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.       Ill 

coagulate  the  blood-albumen,  to  disintegrate  the  blood-pig- 
ment and  impair  the  oxygen-carrying  (germicidal)  power 
of  the  red  corpuscles.  The  use  of  dry  heat  should  be  re- 
stricted to  conditions  characterized  by  passive  hyperemia 
and  by  sluggishness  of  local  and  general  metabolism,  e,  g. 
sprains,  bruises,  chronic  rheumatism,  nephritis,  etc.,  etc.  In 
order  to  "derivate,"  it  is  sometimes  of  advantage  to  apply 
dry  heat  to  a  part  at  some  distance  from  the  inflamed  area. 

The  electric-light  bath  (Kellogg's  incandescent  bath, 
Minin's  thermic-ray  apparatus)  is  also  a  mode  of  applying 
dry  heat.  To  what  extent  and  in  what  manner  the  light  en- 
hances or  modifies  the  action  of  heat,  is  a  matter  of  specu- 
lation. There  is  no  doubt,  however,  that  the  light  itself  adds 
an  element  of  importance  to  the  procedure.  In  the  incan- 
descent bath  a  temperature  of  ii5°F.  is  therapeutically 
equal  to  350°  F.  in  the  hot-air  cylinder  heated  by  gas.  This 
is  the  statement  of  Winternitz,  which  has  been  corroborated 
by  many  other  clinicians.  The  light  which  strikes  the  nude 
skin  has  a  characteristic  action  on  the  skin-nerves  which  is 
absent  in  the  effect  of  the  ordinary  dry-heat  cylinder. 

In  administering  a  general  "bake"  the  body  of  the  pa- 
tient is  covered  with  one  layer  of  bath-toweling  (robe,  mit- 
tens and  stockings).  The  head  is  kept  out  of  the  cylinder. 
The  heat  is  turned  on  and  allowed  to  rise  slowly.  The  pa- 
tient soon  begins  to  sweat.  After  the  heat  has  been  on  for 
twenty  to  thirty  minutes,  the  patient  sweating  profusely,  the 
heat  is  cut  off  and  the  temperature  allowed  to  slowly  drop. 
Vv'hen  it  lias  dropped  to  approximately  100°  F.,  the  plat- 
form should  be  rolled  out,  and  the  patient  quickly  and  thor- 
oughly rubbed  dry.  the  wet  robe,  mittens  and  stockings 
having  been  removed.  The  patient  is  now  pushed  back 
into  the  cylinder  nude,  the  temperature  in  the  cylinder  being 
the  ordinary  comfortable  temperature  which  usually  re- 
mains in  it  after  the  intense  heat  has  been  on  previously. 
The  heat  is  not  turned  on.  The  cylinder  is  closed  so  that 
only  the  head  of  the  patient  protrudes.  A  secondary  sweat 
now  begins  which  can  be  allowed  to  continue  for  one-half 


112  MODERN  PHYSIO-THERAPY. 

hour  or  longer.  The  patient  is  then  taken  out,  dried  off, 
given  a  brisk  cold  rub  and  rubbed  dry.  Then  the  patient  is 
allowed  to  lie  on  a  lounge  and  rest.  During  the  "bake"  the 
patient,  if  he  asks  for  water,  should  be  allowed  to  drink 
sparingly.  The  water  should  not  be  ice-cold.  His  face 
should  be  wiped  frequently. 

It  should  be  remembered  that  temperature  is  purely  a 
relative  term.  The  heat  during  a  "bake"  should  be  regu- 
lated, not  by  the  thermometer,  but  by  the  condition  of  the 
patient.  Precordial  distress,  dyspnea,  palpitation  of  the 
heart,  a  bursting  headache,  syncope,  nausea  are  indications 
that  the  patient  has  passed  the  point  of  tolerance.  The  heat 
should  be  turned  off  at  once  and  cold  water  applied  to  the 
patient's  head.  Sometimes  the  patient  has  to  be  taken  out 
without  delay.  Ordinarily  it  is  sufficient  to  apply  cold  to 
the  patient's  head  and  open  the  vent-holes  of  the  cylinder. 
After  the  "bake"  massage  or  any  other  form  of  treatment 
can  be  administered.  The  patient  should  not  take  a  general 
dry-heat  bath  on  a  full  stomach.  Treatment  of  this  kind 
can  not  be  given  oftener  than  three  times  a  week.  In  many 
cases  two  treatments  a  week  would  be  the  limit.  In  cases  of 
metabolic  disorders,  especially  rheumatism,  the  patient 
should  be  given  the  treatment  up  to  the  limit  of  tolerance. 
In  diseases  of  the  circulatory  organs  and  in  renal  disorders 
mild  treatments  frequently  repeated  are  preferable.  In 
chronic  Bright's  disease  the  application  of  cold  to  the  skin 
is  never  without  some  danger.  Care,  therefore,  should  be 
exercised  in  administering  a  cold  rub-down  after  a  general 
dry-heat  treatment. 

In  administering  a  local  treatment,  e.  g.  to  a  sprained 
ankle,  the  general  condition  of  the  patient  is  visually  of  lit- 
tle concern.  The  technique  is  of  great  consequence.  The 
part  should  be  carefully  covered  with  three,  four  or  even 
more  layers  of  Turkish  toweling  and  placed  in  the  cylinder 
of  suitable  size  in  such  a  way  that  the  heat  will  nowhere 
come  in  contact  with  the  skin.  The  temperature  can  be 
raised  to  the  point  of  tolerance  and  kept  there  as  long  as  the 


PHYSIOLOGICAL  EFFECTS  OF  HEAT  AND  COLD.      113 

patient  does  not  complain.  A  local  "bake"  should  not  last 
longer  than  thirty  minutes,  if  properly  administered.  The 
part  is  not  put  back  for  a  secondary  sweat.  This  is  only 
done  in  giving  the  general  treatment.  Local  treatments 
should  always  be  followed  by  massage.  They  can  be  given 
every  day  or  every  other  day.  The  part,  after  a  bake,  will 
usually  be  found  to  be  red,  warm,  pliable,  without  pain  and 
capable  of  being  manipulated  without  discomfort  to  the  pa- 
tient. In  giving  a  general  treatment  the  most  common  dis- 
agreeable complication  is  fainting.  In  the  local  treatment 
the  operator  should  concentrate  his  attention  upon  the  pos- 
sibility of  burning  the  patient's  skin.  (See  RHEUMATISM.) 
The  high-temperature  thermometer  as  a  gauge  of  the 
degree  of  heat  should  be  freely  suspended  in  the  cylinder 
without  any  metal  cover.  The  latter  makes  the  thermometer 
worthless  because  the  instrument  is  influenced  by  the  intense 
heat  which  is  absorbed  and  retained  by  the  metal  case.  As 
stated  before,  the  condition  of  the  patient  is  the  only  crite- 
rion by  which  the  intensity  of  the  thermic  stimulus  and  the 
duration  of  the  treatment  should  be  judged.  The  princi- 
ples underlying  the  therapeutic  indications  of  dry  heat  are 
included  in  the  discussion  about  HYDRO-THERAPY. 


114  MODKKX    PHYSIO-THERAPY. 


CHAPTER  V. 
MECHANO-THERAPY. 

"MECHANO-THERAPY"  is  a  collective  term  which  in- 
cludes all  forms,  methods  and  systems  of  exercise  and  of 
manual  and  instrumental  manipulation  of  the  tissues  of  the 
hody.  It  may  be  subdivided  as  follows : 

1.  EXERCISE  comprises  the  sum-total  of  the  movements 
v/hich   represent   the   functional   activity   of  the   voluntary 
muscles   of  the  body.      Being  primarily   essential    for   the 
preservation  of  health  locally  and  systemically,  it  is  rather 
a   hygienic  than  a  therapeutic  measure.     When  it  is  per- 
formed methodically  and  as  a  part  of  a  well-conceived  sys- 
tem of  treatment  in  any  given  case,  it  becomes  a  physio- 
therapeutic  measure  and  belongs  properly  under  the  head 
of  Swedish  gymnastics  or  movements. 

2.  SWEDISH    MOVEMENTS   are   a  therapeutic   system   of 
muscular  movements  of  fixed  duration,  direction  and  pur- 
pose.   They  are  sometimes  referred  to  as  "kinesio-therapy" 
( movement-cure ) . 

3.  MASSAGE  is  a  system  of  manipulations  which  are  ad- 
ministered to  the  soft  tissues  of  the  body  by  the  hand  or 
hands  of  a  specially  qualified  operator  or  by  suitable  mas- 
sage-instruments. 

4.  BONE-SETTING  is  ah  empirical  method  of  restoring  the 
functions  of  the  joints  and  of  curing  many  of  the  compli- 
cations and  sequelae  of  fractures,  dislocations,  etc.,  by  the 
breaking-up  of  adhesions  and  by  applying  massage  and  pas- 
sive motion.    Bone-setting  as  a  special  kind  of  craft  is  now 
almost  obsolete. 

5.  ORTHOPEDICS.    Orthopedic  mechano-therapy  is  a  sys- 
tem of  movements  and  manipulations  whose  object  is  the 


MECHANQ-THERAPY.  115 

correction  of  certain  deformities  by  restoring  the  normal 
structural  and  functional  relation  of  certain  parts  of  the 
body  to  each  other  as  far  as  such  restoration  is  possible. 

6.  OSTEOPATHY  is  a  system  of  movements  by  which  dis- 
placements of  bony  structures  are  to  be  corrected,  the  sup- 
position being  that  "all  diseases  are  due  to  definite  lesions 
consisting  of  bony  displacements  and  that  treatment  and 
cure  must  necessarily  consist  in  and  follow  removal  of  the 
cause." 

/.  VIBRATION  is  a  mode  of  mechano-therapeutic  manipu- 
lation by  which  impulses  of  a  more  or  less  energetic  char- 
acter and  with  greater  or  less  rapidity  are  imparted  to  the 
tissues  of  the  body,  the  generating  source  of  vibration  be- 
ing the  hand  of  a  skilled  operator  or  preferably  a  suitably 
constructed  instrument  called  a  "vibrator." 

8.  OSCILLATION  is  a  more  or  less  violent  shaking  up  of 
the  soft  tissues  of  one  or  more  regions  by  the  hand  or  hands 
of  a  trained  operator  or  by  the  application  of  an  instrument 
called  an  "oscillator." 

For  practical  purposes  the  different  modes  of  move- 
ment or  manipulation  can  be  classified  in  a  much  more  sim- 
ple and  concise  manner.  Since  ordinary  exercise  is  to  all 
intents  and  purposes  a  part  of  the  so-called  Swedish  move- 
ments, it  can  practically  be  left  out  of  consideration  as  a 
special  form  of  mechano-therapy.  Bone-setting  is  a  motley 
and  empirical  mixture  of  massage  and  Swedish  movements, 
practiced  by  men  without  technical  knowledge,  but  endowed 
with  a  wonderfully  fine  sense  of  touch  and  a  knack  of 
manipulation.  Orthopedics,  in  as  far  as  it  is  related  to  ma- 
nipulative procedures,  is  also  a  compound  of  massage  and 
Swedish  movements  ,and,  therefore,  does  not  represent  a 
distinct  subdivision.  Osteopathy  was  included  for  the  sake 
of  completeness.  Being  a  drugless  method  or  system  and 
having  the  charm  of  novelty,  it  has  gained  unprecedented 
popularity  in  all  parts  of  the  country.  Neither  its  theories 
nor  the  practical  results  achieved  by  their  application  jus- 
tify the  prominence  which  it  has  achieved  recently.  Noth- 


116  MODERN  PHYSIO-THERAPY. 

ing  can  be  accomplished  by  an  osteopath  that  can  not  be 
done  by  an  expert  Swedish  masseur.  Those  who  extol 
osteopathy  as  a  new  system  of  practice  are  attracted  by  the 
glamour  of  novelty  and,  in  a  measure,  by  its  suggestive  in- 
fluence. Osteopathy,  in  its  approved  form,  can  not  live  be- 
cause its  pathology  is  not  sound  and  its  range  of  practical 
application  is  limited.  The  number  of  osteopaths  who  are 
including  the  other  physio-therapeutic  methods  in  their 
practice  is  constantly  growing,  thus  furnishing  a  mute  but 
eloquent  proof  for  the  clinical  insufficiency  of  the  oste- 
opathic  creed.  The  success  of  osteopathy,  however,  shows 
the  drift  of  the  times  in  the  direction  of  drugless  methods. 
Osteopathy  has  given  a  new  and  powerful  impetus  to  the 
study  of  anatomy  and  physiology  and  to  the  analysis  of  the 
intentions  of  Nature  as  expressed  in  the  sciences  of  hygiene 
and  dietetics.  In  this  respect  the  announcement  of  the 
osteopathic  creed  was  of  historical  moment.  Osteopathy  has 
fulfilled  its  mission.  It  served  as  an  auxiliary  wedge  in 
the  interests  of  an  incomparably  greater  cause,  to  wit : 
physio-therapeutic  medication.  Osteopathy  as  a  system  can 
not  and  will  not  live.  Even  now  the  evidences  of  decay  are 
too  plain  to  be  ignored.  The  well-meaning  and  intelligent 
osteopaths  who  have  a  good  knowledge  of  the  essential 
branches  of  medicine  and  are  correspondingly  well-posted  in 
the  collateral  natural  sciences,  may  continue  under  the  name 
of  osteopaths,  but  they  will,  to  all  intents  and  purposes,  be 
practitioners  of  modern,  i.  e.  physiological  medicine. 

If  we  eliminate  exercise,  bone-setting,  orthopedics  and 
osteopathy  from  our  classification,  raechano-therapy  still  re- 
tains four  subdivisions,  to  wit:  massage,  Swedish  move- 
ments, vibration  and  oscillation.  If  the  latter  two  are  ap- 
plied by  means  of  the  hand,  they  belong  properly  under 
the  head  of  massage.  They  are  a  special  or  specific  form 
of  mechanical  treatment  if  they  are  instrumentally  applied. 
It  would  seem,  therefore,  as  though  the  mechano-therapeutic 
methods  could  well  be  divided  into  those  which  are  applied 
by  hand  (manual)  and  these  which  are  strictly  instrumental. 


MECHANO-THERAPY.  117 

In  keeping  with  this  simple  and  convenient  classification  I 
shall  endeavor  to  present  the  strictly  manual  methods  under 
the  heads  of  massage  and  Swedish  movements,  and  the  in- 
strumental methods  respectively  under  the  heads  of  instru- 
mental massage,  instrumental  gymnastics,  vibration  and 
oscillation. 

Massage. 

Massage  is  the  oldest  mechano-therapeutic  method  be- 
cause its  practice  is  suggested  by  the  very  sensory  and  motor 
instincts  of  the  organism.  When  a  man  receives  a  sudden 
bruise,  he  will  instinctively  grasp  the  injured  part,  stroke  it 
and  rub  it.  When  a  child  falls  and  bruises  its  forehead,  the 
mother  will  press  and  stroke  and  rub  the  bruised  portion 
until  the  child,  partly  as  the  result  of  the  massage  adminis- 
tered and  partly  in  response  to  the  suggestive  influence  of 
the  mother's  caresses,  will  become  quiet  and  perhaps  fall 
asleep.  A  man  rubs  his  leg  when,  for  some  reason  or  other, 
it  hurts.  A  good  rubbing  is  the  accepted  form  of  treatment 
for  lumbago,  although  the  average  man  is  prepared  to  give 
credit  to  some  liniment  employed  rather  than  to  the  rubbing 
which  is  the  real  remedy.  The  experienced  old  woman 
strokes  the  brow  of  the  fever-patient  who  complains  of  a 
headache.  Even  among  the  lower  animals  the  instinct  of  re- 
lieving discomfort  or  pain  by  massage  is  well  marked.  Who 
has  never  seen  a  dog  or  a  cat  licking  an  injured  limb  ?  Who 
has  never  beheld  the  pleased  expression  on  a  dog's  or  a  cat's 
face  in  response  to  and  in  grateful  appreciation  of  a  gentle 
rubbing?  The  sedative  and  anodyne  effect  of  massage  is 
generally  known.  There  seems  to  be  no  doubt  that  the 
healing  by  the  laying  on  of  hands  which  is  spoken  of  in 
the  New  Testament  and  was  en  vogue  among  the  early 
Christians  refers  to  a  crude  form  of  massage. 

The  elaboration  of  massage  as  a  therapeutic  measure  is 
the  work  mainly  of  two  men :  P.  H.  Ling,  a  Swede  of  much 
versatile  talent,  who  tried  to  systematize  the  subject  during 
the  early  part  of  the  nineteenth  century,  and  Prof.  Mezger, 
formerly  of  Amsterdam,  later  of  Wiesbaden,  who  is  really 


118  MODERN  PHYSIO-THERAPY. 

the  scientific  originator  oi  massage  as  a  branch  of  practical 
therapeutics.  The  system  followed  by  Mezger  is  adhered 
to  by  masseurs  generally.  He  recognizes  massage  (from  the 
Greek  word  massein,  to  knead)  as  a  system  of  manipulation 
applied  to  the  soft  parts  for  certain  purposes  and  according 
to  certain  rules.  He  distinguishes  four  different  varieties  of 
massage-movements,  to  wit:  stroking  (tfHeurage) ,  rubbing 
(friction),  kneading  (petrissage)  and  beating  (tapote- 
ment).  In  reality  there  are  but  three  fundamental  varieties, 
to  wit : 

EFFLEURAGE. — Under  this  head  are  included  all  varieties 
of  massage  consisting  of  pressure  evenly  and  uniformly  con- 
tinued along  a  certain  path.  This  path  may  be  a  straight  line 
(linear  efileurage)  or  a  more  or  less  curved  line  (circular 
effleurage).  The  latter  variety  coincides  with  Mezger's 
friction.  The  means  of  which  the  operator  avails  himself 
for  the  purpose  of  administering  evenly  continued  pres- 
sure along  a  given  path  (effleurage)  are  suggested  by  the 
topographical  characteristics  of  the  region  treated  or  by  the 
effect  to  be  produced.  The  operator  may  use  the  palm  of 
one  hand  (for  extremities,  posterior  portion  of  head),  or 
both  palms  (for  chest,  back,  both  sides  of  neck,  extremities 
of  adults  of  large  stature),  one  or  both  thumbs  (for  inter- 
muscular  spaces,  inter-ossei),  or  the  tips  of  the  fingers 
(whenever  it  is  necessary  to  adapt  one's  self  to  the  peculiar 
shape  of  a  part,  e.  g.  a  joint).  It  seems  entirely  proper  to 
classify  el'fleurage  and  friction  under  the  same  head.  They 
only  differ  in  the  direction  in  which  the  stroking  is  done. 
It  is  important  to  remember  that  friction  should  always  be 
followed  by  centripetal  effleurage,  /'.  e.  by  stroking-massage 
from  the  periphery  towards  the  center  (in  the  direction  of 
the  venous  and  lymphatic  circulation). 

PETRISSAGE  is  the  manipulation  and  kneading  of  a  part 
between  the  fingers  or  hands  of  the  operator  (simple  petris- 
sage)  or  between  the  operator's  hand  or  some  part  of  it  and 
the  underlying  hard  tissues  of  the  patient  (compound 
petrissage).  Simple  petrissare  would  be,  for  instance,  the 


MECHAXO-THERAPV.  119 

picking  up  and  kneading  of  the  body  of  the  biceps  muscle  of 
the  patient  between  the  thumb  and  index  finger  of  the  oper- 
ator. If  the  operator  were  to  place  the  fingers  or  the  palm 
over  the  biceps  and  knead  the  latter  against  the  resisting 
hard  tissue  of  the  humerus  below,  this'  would  be  a  case  of 
compound  petrissage.  If  the  operator  were  to  place  the  up- 
per arm  of  the  patient  between  the  palms  of  his  own  hands 
and  knead  the  arm  vigorously,  it  would  be  a  mixture  of  the 
two  varieties.  In  petrissage  the  fingers  or  hands  of  the 
operator  do  not  glide  over  the  skin  of  the  patient,  but  re- 
main in  firm  contact  with  it,  carrying  it  along.  Petrissage 
may  be  done  with  two  thumbs  or  with  the  thumb  and  fingers 
of  one  hand  or  with  both  hands.  Petrissage  is  a  mixture  of 
varying  pressure,  squeezing  and  pinching.  It  is  useful  for 
the  purpose  of  stimulating  the  local  metabolism  and  of  loos- 
ening adherent  and  contractured  fibers. 

TAPOTEMENT  (percussion)  consists  in  slapping,  clapping, 
beating  or  chopping  the  parts  by  means  of  the  tips  of  the 
fingers,  the  palms  of  the  hands,  the  whole  palmar  surface, 
the  ulnar  side  of  the  hands  or  the  fist,  as  the  case  may  be. 
The  succession  of  blows  which  are  thus  administered  to  the 
soft  parts  have  an  intensely  stimulating  effect  and  prepare 
the  parts  for  other  forms  of  massage. 

The  principal  technical  difference  between  effleurage  and 
petrissage  is  that  in  the  former  the  fingers  or  hands  of  the 
operator  glide  over  the  skin  of  the  patient,  while  in  petris- 
sage the  skin  of  the  patient  is  carried  along  in  order  to  act 
upon  the  subcutaneous  and  deeper  structures.  There  is  no 
sliding  except  when  it  becomes  necessary  to  change  to  an- 
other area.  In  giving  the  different  forms  of  effleurage  the 
patient's  skin  should  be  slightly  anointed.  The  best  sub- 
stance for  this  purpose  is  olive-oil,  although  lard  and  vase- 
line are  largely  used  by  many  good  operators.  On  hairy  sur- 
faces, oil  should  be  used  liberally.  All  forms  of  massage 
must  be  given  on  the  nude  skin. 

Massage  is  an  art  which  can  not  be  taught  except  by 
actual  demonstration.  Much  depends  upon  the  aptitude  of 


120  MODERN  PHYSIO-THERAPY. 

the  masseur  or  masseuse  who  will  eventually  educate  his  or 
her  touch  (tactus  eruditus),  without  which  massage  will 
necessarily  always  remain  bunglesome  and  amateurish.  The 
operator  should  cultivate  clean,  soft  and  well-groomed 
hands.  Cleanliness  is  a  factor  of  prime  importance.  The 
patient's  skin  should  be  cleaned  with  alcohol  before  the  treat- 
ment, and  hot  water  and  soap  after  massage  has  been  ad- 
ministered. Massage  does  not  mean  strength  on  the  part 
of  the  operator.  A  good  masseur  spends  but  little  energy. 
Beginners  are  likely  to  overdo  things  and  bruise  the  patient. 
Experience  means  everything  in  this  respect. 

The  physical  elements  which  go  to  make  up  the  different 
movements  of  massage,  are  ( i )  contact,  or  the  simple  juxta- 
position of  two  surfaces  (skin  of  operator  and  skin  of  pa- 
tient) ;  (2)  pressure,  or  the  application  of  a  certain  amount 
of  energy  to  the  touching  surfaces;  (3)  variation  of  pres- 
sure, or  the  change  of  the  direction  or  the  intensity  of  the 
pressure  applied.  The  physical  effect  of  contact  is  stimula- 
tion, both  motor  and  sensory.  Simple  contact  causes  an  im- 
pression to  which  cellular  bodies  respond  by  an  attempt  at 
contraction.  The  amoeba  contracts  very  energetically  in 
response  to  mere  contact.  In  animal  bodies  contact  starts  a 
wave  of  energy  which  travels  along  the  pathways  of  nerve- 
force.  Sensation  is  a  part  of  the  nerve-impression  which 
contact  produces.  The  mysterious  role  which  the  nervous 
system  plays  in  the  life-processes  of  the  animal-body  has 
opened  up  a  wonderful  and  almost  unlimited  field  for  specu- 
lation along  the  lines  of  animal  magnetism  or  psycho-mag- 
netism, with  all  its  vagaries  and  wonderful  phenomena,  real 
and  alleged.  The  effect  of  massage  can  be  fully  explained 
without  resorting  to  the  mysticism  of  magnetic  healing. 
The  effects  of  massage  are  either  physical  or  physiological. 

The  physical  effects  are  mainly  thermic  in  character. 
Motion  or  friction  produces  heat.  An  increase  in  the  tem- 
perature of  a  living  organism  up  to  a  certain  point  means  in- 
creased speed  in  the  wearing  away  of  substance  and  aug- 
mented intensity  in  the  usage  of  the  force  consumed.  Phy- 


MECHANO-THERAPY.  121 

siologically  the  effects  of  massage  are  produced  through 
the  circulatory  apparatus,  especially  the  arterioles  and  the 
nerve-mechanism  controlling  them.  Arterial  stimulation, 
active  hyperemia,  increased  functional  activity,  more  ac- 
tive nutrition,  secretion,  excretion,  absorption,  in  fact  more 
rapid  and  thorough  metabolism  in  the  part  or  parts  sub- 
jected to  massage,  are  the  links  in  the  chain  of  the  physiolog- 
ical phenomena  produced  by  massage. 

Massage  causes  a  rise  in  the  arterial  pressure  which  is 
invariably  associated  with  a  coincident  stimulation  of  the 
venous  and  lymphatic  flow.  Excretion  through  lungs,  skin, 
bowels  and  kidneys,  as  a  result  of  general  massage,  is  in- 
creased. Metabolism  improves.  In  a  general  way  these 
effects  represent  the  range  of  therapeutic  usefulness  of  mas- 
sage locally  and  generally,  as  will  be  seen  by  the  following 
resume  of  the  experimental  work  done  by  a  number  of  ob- 
servers. 

Tapotement  over  the  heart  and  in  the  inter-scapular 
space  is  followed  by  retardation  and  increased  fullness  of 
the  pulse.  The  excretion  of  CO«  through  the  lungs  is 
diminished.  The  accumulation  of  CO*  in  the  blood  and  the 
subsequent  irritation -of  the  vagus  and  the  vaso-motor  nerves 
probably  account  for  the  effect  referred  to.  Tapotement 
over  the  stomach  and  intestines  causes  a  decrease  in  the  ab- 
dominal arterial  circulation,  which,  however,  is  only  tem- 
porary. A  reaction  soon  takes  place  which  brings  about  a 
most  decided  active  hyperemia  and  increased  functional  ac- 
tivity. Superficial  effleurage,  both  linear  and  circular,  stimu- 
lates the  circulation.  Deep  massage  depresses  the  heart's 
action  and  retards  the  pulse. 

General  massage  excites  the  vaso-motors  and  in  this 
way  causes  constriction  of  the  peripheral  vessels  and  in- 
creased blood-pressure  in  these  vessels.  Eventually  the 
venous  flow  is  increased.  The  heart  in  response  to  the  in- 
creased demand  for  vis  a  tergo  beats  faster  and  fuller.  The 
resulting  fatigue  from  overwork  causes  depression  of  the 
heart's  action.  The  arteries  of  the  periphery  dilate  and  in 


122  MODERN  PHYSIO-THERAPY. 

this  way  relieve  the  heart.  Deep  abdominal  massage  re- 
lieves the  vessels  of  the  periphery.  The  hands  and  feet 
grow  cold  from  lack  of  arterial  blood.  Intra-cranial  anemia 
may  cause  the  patient  to  faint.  Thus  we  see  that  massage 
acts  most  energetically  upon  the  circulation.  As  far  as  the 
hematopoietic  function  is  concerned,  it  is  believed  that  mas- 
sage is  capable  of  increasing  the  amount  of  the  blood-color- 
ing matter  and  also  the  number  of  red  blood-cells. 

The  experiments  of  Winternitz  have  demonstrated  the 
influence  of  massage  on  the  heat-production  and  heat-radia- 
tion in  the  animal  economy.  General  effleurage  causes  a 
tremendous  increase  in  the  radiation  of  heat-units  from  the 
body.  The  temperature  drops,  which  clearly  shows  the 
value  of  massage  as  an  antipyretic  in  the  acute  fevers.  The 
immense  radiation  of  heat  through  the  skin  causes  the  sur- 
face-temperature to  increase  while  the  body-temperature 
(rectal)  drops. 

Massage  stimulates  the  action  of  the  absorbent  vessels  in 
a  marked  degree.  This  has  been  abundantly  proven  by  ex- 
periments on  animals.  A  definite  quantity  of  water  was  in- 
jected into  the  peritoneal  cavity  of  rabbits.  One  animal 
was  killed  after  One  hour  and  the  quantity  of  water  re- 
maining was  measured.  Another  animal  was  killed  after 
two  hours,  another  after  three  hours,  accurate  measure- 
ments of  the  water  remaining  being  made.  A  fourth  ani- 
mal was  given  abdominal  massage  after  the  injection  of 
water.  It  was  found  that  massage  caused  the  fluid  to  be 
absorbed  twice  as  fast  as  it  would  be  without  massage.  In- 
jections of  red  ink  into  the  knee-joints  of  an  animal,  one 
joint  being  subjected  to  massage  after  the  injection,  showed 
that  massage  had  caused  the  ink  to  disappear  entirely  from 
the  massaged  joints  and  to  appear  in  the  lymph-vessels  as 
high  up  as  the  hip.  In  the  other  joint  no  change  had  taken 
place. 

The  salol  experiment  of  Ewald  furnishes  probably  the 
most  exact  and  conclusive  evidence.  Ewald  demonstrated 
that  salol,  being  insoluble  in  the  gastric  juice,  is  broken  up 


MECHANO-THERA'PY.  123 

into  its  chemical  constituents  a;:J  thus  rendered  soluble  in 
the  alkaline  contents  of  the  duodenum.  It  is  thus  readily  ab- 
sorbed and  finally  excreted  through  the  kidneys  as  salicyl- 
uric  acid  and  sulpho-carbolic  acid.  After  acidulating  the 
urine  with  HC1  and  shaking  with  ether,  a  little  perchloride 
of  iron  solution  is  added,  the  reaction  taking  place  by  the 
production  of  a  reddish  violet  precipitate.  In  dogs  whose 
pylorus  has  been  ligated,  the  test  is  negative.  The  reaction 
in  the  urine  of  dogs  takes  place  about  forty-five  minutes 
after  administering  the  salol.  If,  after  giving  salol,  the  ab- 
domen is  massaged,  the  reaction  in  the  urine  can  be  verified 
in  about  twenty-five  minutes.  The  salol  reaction  in  the 
urine  of  man  ordinarily  takes  place  in  from  two  to  three 
hours.  If  massage  is  given,  the  reaction  takes  place  in  about 
an  hour,  showing  the  intense  effect  of  massage  on  meta- 
bolism. All  secreting  glands  (salivary,  gastric)  can  be 
stimulated  and  their  secretion  increased  by  massage.  Skin- 
massage  augments  the  excretion  of  water  through  the  skin 
60  p.  c.  General  massage  has  been  shown  to  increase  the 
quantity  of  urine,  the  proportionate  amount  of  uric  acid 
and  solids  in  the  urine.  It  stimulates  the  appetite,  the  power 
of  assimilation  and  the  conversion  of  albumins.  It  increases 
the  proportion  of  HC1  in  the  gastric  juice.  The  fat-output 
in  the  feces  is  much  lessened.  Massage  augments  the  flow 
of  lymph  in  the  thoracic  duct  and  in  the  lymphatic  vessels 
generally.  In  this  respect  massage  acts  like  exercise.  In 
an  active  organ  the  flow  of  lymph  is  steady,  whereas  in  a 
condition  of  rest  of  the  organ  the  circulation  of  lymph  is 
almost  suspended. 

Boas  demonstrated  that  regurgitation  of  the  intestinal 
contents  into  the  stomach  through  the  pylorus  can  be  accom- 
plished by  kneading  of  the  abdomen  from  the  right  iliac 
space  toward  the  median  line.  Massage  in  the  direction  of 
the  peristaltic  movement  augments  the  latter  and  regulates 
the  bowel-function.  The  desire  to  have  a  stool,  which 
usually  follows  a  meal,  especially  breakfast,  is  due  to  the 
pressure  of  the  stomach  on  the  superior  mesenteric  plexus 


124  MODERN  PHYSIO-THERAPY. 

and  exemplifies  the  effect  of  pressure  on  the  movements  of 
the  intestines. 

The  effect  of  massage  on  the  nervous  system  is  of  the 
utmost  clinical  importance.  Nerves  are  stimulated  by  mas- 
sage until  a  certain  point  is  reached  when  overstimulation 
manifests  itself  by  a  condition  of  fatigue  and  rest.  Thus 
massage  over  a  healthy  nerve  causes  local  irritability  and 
pain  as  the  result  of  stimulation.  Massage  along  the  course 
of  an  aching  nerve  is  invariably  followed  by  relief  of  pain 
(through  stimulation  which  is  equivalent  to  increased  nu- 
trition and  healthy  blood-supply).  Mild  pressure  increases 
the  irritability  of  nerves,  firm  pressure  lessens  and  eventually 
suspends  it.  A  few  examples  might  serve  to  illustrate  these 
points.  Continued  light  pressure  over  the  occipital  nerves 
is  a  sedative  of  wonderful  power.  Pressure  upon  the 
phrenic  in  the  neck  relieves  spasm  of  the  diaphragm.  Cramps 
or  tremor  of  muscles  can  be  controlled  by  pressure  upon  the 
corresponding  peripheral  motor  nerve.  Strong  pressure 
upon  a  nerve  controls  the  pain  of  neuralgia  of  that  nerve. 
It  has  likewise  been  shown  that  deep  structures  can  be 
reached  and  acted  upon  by  vibratory  and  other  forms  ol 
massage  of  the  surface  as  long  as  the  nerves  of  the  region 
treated  and  of  the  deep  part  to  be  reached  come  from  the 
same  segment  of  the  cord.  Spasmodic  conditions  of  the 
bronchioles  and  of  the  circular  muscular  fibers  of  the  intes- 
tines are  relieved  by  tapotement  or  vibration  over  the  sur- 
face nearest  them. 

Maggiora  studied  the  effect  of  massage  on  muscles  with 
the  aid  of  the  ergograph  and  found  that  massage  applied  to 
resting  muscles  increases  their  power  for  work  and  retards 
fatigue,  that  it  prevents  the  accumulation  of  fatigue-prod- 
ucts in  a  muscle,  that  it  qualifies  a  muscle  for  work  more 
than  a  corresponding  amount  of  rest,  that  the  different  forms 
of  massage  affect  muscles  in  different  ways,  that  massage 
increases  not  only  the  capacity  for  work,  but  actually  stimu- 
lates the  growth  and  development  of  muscle-tissue,  that 
massage  restores  the  tone  and  strength  of  muscles  if  the 


MECHANO-THERAPY.  125 

latter  have  suffered  from  the  activity  of  any  cause  that  has 
affected  the  whole  system,  e.  g.  overexertion,  physical  or 
mental.  The  researches  of  Maggiora,  as  well  as  those  of 
other  observers  whose  experimental  work  has  been  pre- 
viously alluded  to,  are  quoted  by  Gerdine  in  an  excellent 
compilation  of  the  literature  and  bibliography  of  the  sub- 
ject. 

With  the  physiological  effects  of  massage  firmly  fixed  in 
our  mind  the  application  of  massage  becomes  as  much  of  a 
problem  in  clinical  medicine  as  the  use  of  any  other  thera- 
peutic agent.  The  centra-indications  are  easily  understood. 
Massage  should  not  be  practiced  on  sore,  inflamed  or  broken 
skin,  over  atheromatous  blood-vessels,  in  cancer  or  abscess 
on  account  of  the  danger  of  encouraging  metastasis,  in  in- 
flammatory and  painful  affections  of  the  deep  tissues,  nota- 
bly the  bones,  in  pregnancy,  in  fact  in  all  cases  where  the 
benefits  derived  from  massage  would  be  more  than  counter- 
balanced by  the  local  or  systemic  damage  done.  Frequently 
it  is  of  advantage  to  massage  the  parts  which  are  near  the 
seat  of  trouble.  In  this  way  the  neighboring  lymphatics  can 
be  stimulated  and  absorption  of  inflammatory  products, 
waste,  etc.,  started.  It  is  important  to  remember  that  the 
veins  and  lymphatics  are  near  the  internal  border  of  the 
fiexor  muscles  and  that  the  massage  movements  should  be  in 
a  centripetal  direction.  Muscles  that  are  being  massaged 
should  be  in  a  thoroughly  relaxed  condition.  The  average 
duration  of  local  massage  is  ten  to  fifteen  minutes,  of  gen- 
eral massage  one-half  hour  to  an  hour. 

GYNECOLOGICAL  MASSAGE. — The  application  of  massage 
in  the  treatment  of  many  diseases  peculiar  to  women  was 
given  to  the  profession  by  a  layman,  Thure  Brandt,  an  offi- 
cer in  the  Swedish  army,  who,  like  many  educated  Swedes, 
was  a  master  of  the  art  of  massage  and  was  led  to  apply 
its  principles  to  a  condition  of  prolapsus  uteri  from  which 
his  own  wife  suffered.  The  skill  of  the  accomplished  mas- 
seur, coupled  with  the  tender  love  for  and  devotion  to  a 
good  wife,  resulted  ia  a  complete  cure  and  established  the 


126  MODERN  PHYSIO-THERAPY. 

possibilities  of  massage  in  gynecological  practice.  That 
Thure  Brandt's  method,  if  applied  by  an  unprejudiced  mind 
and  a  skilled  hand,  is  an  agent  of  wonderful  power,  has 
been  established  beyond  the  shadow  of  a  doubt.  It  is  ad- 
vocated and  practiced  by  conservative  gynecologists  the 
world  over.  The  opposition  to  it  comes  exclusively  from 
those  who  know  nothing  about  it  and  others  who  discoun- 
tenance any  method  of  treatment  except  surgery.  Gyne- 
cological massage  has  long  ceased  to  be  the  method  of  a 
layman  whose  work  bore  the  ear-marks  of  empiricism.  It 
has  been  systematized  by  men  of  unquestioned  ability,  e.  g. 
Saenger. 

Ziegenspeck,  in  his  excellent  book  on  "Thure  Brandt 
Massage,"  summarizes  the  indications  of  and  centra-indica- 
tions to  this  form  of  mechano-therapy  in  a  most  practical 
manner.  Brandt  himself  states  with  his  characteristic  la- 
conic brevity  that  pus  and  cancer  are  the  only  contra-indi- 
cations.  Ziegenspeck  interprets  Brandt's  epigrammatic 
statement  by  including  under  the  head  of  cancer  every  ma- 
lignant new  formation,  and  under  that  of  pus  all  infectious 
germs  in  the  internal  genitalia.  We  might  add  all  acute  in- 
flammatory conditions  in  or  near  the  genital  tract  and  also 
pregnancy.  It  is  well  to  remember  the  liquified  products  of 
a  purulent  inflammation  eventually  lose  their  infectious  char- 
acter and,  therefore,  are  no  centra-indications  to  massage 
(e.  g.  chronic  pyo-salpinx).  Massage,  according  to  Zie- 
genspeck, is  indicated  in  chronic  ovaritis,  peri-ovaritis,  sal- 
pingitis,  hydro-  and  pyo-salpinx,  chronic  peritonitis  (fibrin- 
ous  or  adhesive),  pelvic  exudates,  chronic  inflammatory  con- 
ditions in  or  near  the  uterine  body.  The  classical  type  of 
technique  which  Brandt  originated  consists  in  the  introduc- 
tion of  the  index  and  middle  finders  of  the  left  hand  into  the 
vagina  up  to  the  seat  of  trouble  and  fixation  of  the  latter  by 
the  counter-pressure  of  the  right  hand,  which  is  placed  on 
the  abdomen.  The  manipulation  of  the  affected  part  re- 
sults in  a  stretching,  a  toning  up  of  the  chronically  in- 
flamed tissues  and  a  loosening  up  of  adhering  bands.  In 


MECHANO-THERAPY.  127 

addition  to  this  form  of  local  treatment  Brandt  applies 
general  Swedish  movements  and  makes  suitable  hydro- 
therapeutic  applications  to  produce  a  ''derivating"  action. 
The  application  of  Brandt's  method  requires  endurance  and 
a  special  kind  of  technical  skill  which  can  only  be  acquired 
by  experience  and  constant  practice.  Theoretical  knowl- 
edge is  not  sufficient  to  enable  one  to  practice  Brandt's  mas- 
sage successfully  or  to  give  an  intelligent  opinion  concern- 
ing its  relative  merits.  1  he  best  schooling  is  to  attempt  the 
treatment  in  a  mild  case  of  prolapsus  or  in  one  of  pelvic 
exudate.  Perseverance  in  the  treatment  and  constant  men- 
tal concentration  on  the  theoretical  points  involved  will  soon 
— after  a  few  weeks — give  practical  knowledge  to  the  opera- 
tor and  relief  to  the  patient.  Incidentally  good  anatomical 
knowledge  of  the  pelvic  contents  of  woman  will  facilitate 
progress  very  materially.  In  conclusion  let  me  add  that 
Brandt's  massage  has  been  applied  to  cases  of  prolapsus 
recti  with  much  success. 

Swedish  Movements. 

According  to  P.  H.  Ling  "a  movement  is  any  form  of 
exercise  with  a  fixed  duration,  direction  and  purpose."  The 
systematic  employment  of  such  movements  is  the  object  of 
that  branch  of  mechanical  therapeutics  known  as  Swedish 
movements,  gymnastics,  kinesio-therapy  (Schwedische  Heil- 
gymnosttk). 

A  "movement"  consists  in  the  change  of  the  body  or  any 
part  of  it  from  a  given  position  to  another  position  accord- 
ing to  certain  rules.  The  movement  begins  with  a  fixed 
position  of  the  body  or  of  a  part  of  the  body.  The  body  or 
a  part  of  the  body  goes  through  a  motion  of  fixed  speed, 
rhythm,  direction  and  extent,  until  a  position  is  reached  in 
which  the  performance  of  the  motion  is  supposed  to  termi- 
nate. Ling,  who  has  systematized  this  form  of  mechanical 
therapy  in  a  most  ingenious  manner,  recognized  five  princi- 
pal positions  of  the  body  ( standing,  sitting,  lying,  kneeling, 
hanging)  and  numerous  secondary  positions  which  are  va- 


128  MODERN  PHYSIO-THERAPY. 

nations  of  or  deviations  from  the  five  principal  positions 
(squatting,  standing  on  one  foot,  standing  with  legs  sep- 
arated, standing  with  outstretched  arms,  leaning  backward, 
bending  forward,  sitting  astraddle,  lying  on  back  or  side, 
etc.,  etc.,  etc.).  These  positions  are  the  beginning  and  the 
end  of  a  "movement." 

The  "movements"  proper  are  suggested  by  the  normal 
functions  of  the  muscles  of  the  organism.  There  are  three 
principal  movements,  to  wit :  flexion,  extension,  and  rota- 
tion. Ling  enumerates  eight  more,  which,  however,  are  but 
sub-varieties  of  the  three  principal  movements  and  are 
best  discussed  as  such. 

Flexion  (bending)  is  the  motion  of  one  or  more  flexor 
muscles;  extension  (straightening)  consists  in  the  exercise 
of  extensor  muscles;  rotation  (prohation,  supination  or 
both)  is  the  turning  of  a  part  around  its  longitudinal  axis. 

If  the  patient  performs  a  movement  by  his  own  will  and 
effort,  unaided  and  unhindered,  the  movement  is  active. 

If  the  patient  does  not  perform  the  movement  by  his  will 
and  effort,  but  allows  the  operator  to  cause  certain  muscles 
(of  the  patient)  to  relax  or  contract  in  response  to  the 
operator's  will  and  effort,  the  movement  is  passive. 

If  the  patient  performs  a  movement  and,  while  doing  so, 
overcomes  resistance,  the  movement  is  called  concentric. 

If  the  patient  resists  the  efforts  of  the  operator  to  ex- 
tend, flex  or  rotate  certain  muscles  (of  the  patient),  the 
movement  is  called  ex  centric  (eccentric). 

To  illustrate :  If  the  patient  is  told  to  bend  his  arm  and 
does  so  unaided  and  unhindered,  he  is  performing  an  active 
movement.  If  the  operator  grasps  the  patient's  arm  at  the 
wrist  and  near  the  shoulder  and  bends  the  patient's  elbow, 
Ihe  patient  neither  co-operating  nor  resisting,  the  move- 
ment is  a  passive  one.  If  the  patient  bends  his  arm  while 
the  operator  holds  the  arm  and  resists  the  patient's  effort, 
the  movement  is  concentric.  If  the  operator  tries  to  bend 
the  patient's  arm  while  the  patient  resists,  the  movement  is 
ex  centric. 


MEC  HA  NO-THERAPY.  129 

The  position  of  the  patient's  body  and  the  motion  to  be 
performed  are  indicated  in  the  name  which  Ling  gave  to 
the  different  "movements."  Thus,  he  speaks  of  lying-flexion 
of  the  body.  The  patient  is  in  the  primary  lying  position. 
The  flexion  of  the  body  in  gradually  assuming  the  final  sit- 
ting position  is  the  movement  to  be  performed. 

In  discussing  massage  I  have  indicated  the  physiological 
meaning  and  importance  of  exercise.  Whatever  has  been 
said  concerning  this  subject,  holds  good  in  regard  to  the  so- 
called  Swedish  movements.  Inasmuch  as  "movement"  is 
to  all  intents  and  purposes  exaggerated  exercise,  the  state- 
ments concerning  the  physiology  of  exercise  might  be  re- 
peated with  additional  emphasis  in  regard  to  Swedish  move- 
ments. To  exercise  a  muscle  means  to  preserve  its  func- 
tional capacity  (power  of  contraction  and  relaxation).  It 
means  to  regulate  the  process  of  local  metabolism  (nutri- 
tion, assimilation  and  excretion).  Work,  in  its  physiolog- 
ical sense,  is  inseparable  from  life.  Life,  objectively  con- 
sidered, is  the  sum-total  of  physiological  activities.  The 
body  or  any  part  of  it  needs  exercise  to  keep  it  in  a  physi- 
ologically normal  state.  Lack  of  exercise  means  a  depres- 
sion of  the  process  of  metabolism.  Oxidation  (combustion) 
becomes  imperfect  and  sluggish,  the  waste  products  are  not 
thrown  out,  but  accumulate,  and  impair  the  functional  and 
structural  integrity  of  living  tissue.  Venous  congestions  are 
the  result.  The  nerves  are  ill  nourished.  The  whole  or- 
ganism suffers.  The  resisting  power  of  the  body  is  less- 
ened. Locally  and  systemically  the  quality  of  the  tissues 
of  the  body  is  below  par, — all  for  the  want  of  a  physiolog- 
ical necessity,  namely  exercise. 

The  muscular  system  requires  its  period  of  alternate 
work  and  rest,  of  contraction  and  relaxation.  This  is  a 
physiological  law,  the  violation  of  which  means  disease  in 
its  thousand  various  forms.  The  greatest  preventive  of 
disease  is  the  preservation  of  the  resisting  power  of  the  or- 
ganism. Therein  lies  the  enormous*  importance  of  exercise 
or,  in  its  methodical  form,  of  Swedish  movements.  If  the 


130  MODERN  Pnvsio-TiiKKAi'v. 

muscles,  ligaments  and  tendonr>  h-ve,  as  a  result  of  disuse 
or  of  inflammatory  conditions,  lost  some  of  their  functional 
power  and  have  become  atrophied  or  contractured,  exercise 
of  these  parts  is  the  physiological  remedy.  Therein  lies  the 
therapeutic  importance  of  Swedish  movements.  Their  power 
of  modifying  metabolism  makes  them  a  blood-producer  of 
greatest  value.  They  increase  nutrition  and  improve  it  by 
augmenting  the  quantity  and  altering  the  quality  of  the 
blood.  The  function  of  the  lymphatics  is  stimulated.  Respi- 
ration is  improved.  The  whole  organism,  in  all  its  vital 
functions,  receives  the  benefit. 

To  illustrate  these  physiological  considerations  and  their 
application  in  the  practice  of  the  therapeutic  indications  in- 
volved, I  will  confine  myself  to  giving  a  few  of  the  most 
characteristic  movements.  After  the  reader  has  thoroughly 
grasped  the  underlying  principles  of  these  movements  in 
their  relation  to  the  functions  of  the  organism  and  its  parts, 
he  will  have  no  difficulty  in  enlarging  the  scope  of  applica- 
tion and  in  adapting  many  kinds  of  movements  to  the  never- 
ending  varieties  of  disease  and  diseased  conditions. 

In  the  treatment  of  habitual  constipation  Swedish  move- 
ments can  often  be  employed  with  much  advantage.  The 
object  of  all  these  movements  is  to  make  pressure  upon  the 
abdominal  contents,  to  firmly  contract  the  muscles  compos- 
ing the  anterior  abdominal  wall  and  to  act  upon  the  celiac 
and  hypogastric  plexus  which  control  the  mechanism  of  the 
bowel-function.  The  simplest  movement  is  the  slow  bend- 
ing of  the  body  forward  while  the  patient  stands  or  sits. 
The  patient  while  standing  bends  forward  without  bending 
his  knees  and  until  the  tips  of  the  fingers  touch  the  toes. 
The  movement,  both  forward  and  back  to  the  standing  posi- 
tion, should  be  performed  slowly  and  repeated  ten  to  fifteen 
times.  Another  movement  is  the  slow  raising  of  one  or  both 
legs  without  bending  the  knees,  while  the  patient  lies  on  his 
back.  Still  another  is  the  suspended  position,  the  patient 
alternately  drawing  his1  legs  up  to  his  body  and  extending 
them.  Some  of  these  movements  can  be  exaggerated  and 


MECHANO-THERAPY.  131 

thus  be  made  more  effective.  Instead  of  lying  on  a  couch 
full  length,  the  patient  can  lie  down  on  a  table  or  bed  with 
his  hips  on  the  edge,  leaving  the  lower  extremities  without 
support.  This  position  makes  the  movement  of  raising  the 
extremities  much  more  of  an  effort.  Another  variation,  con- 
sists in  lying  down  on  a  couch,  drawing  the  knees  up  toward 
the  abdomen  and  then  extending  the  legs. 

In  the  treatment  of  many  cases  of  tuberculosis  pul- 
inoinun,  Swedish  movements  are  of  great  value,  especially 
in  increasing  the  expanding  power  of  the  chest.  I  beg  to 
refer  the  reader  to  the  second  part  of  this  book  where,  un- 
der the  head  of  TUBERCULOSIS,  this  subject  is  considered  at 
some  length. 

Swedish  movements  are  advantageously  combined  with 
massage,  galvanism  and  faradism.  The  principal  thing  is  to 
not  abuse  a  good  thing  by  overdoing  it  or  by  misapplying 
it.  To  have  exhausted  the  patient  completely  is  a  sure  sign 
that  the  judgment  of  the  operator  is  at  fault.  Massage  or 
movements  should  never  cause  pain,  exhaustion  or  other 
damage.  In  some  cases  it  might  be  desirable  to  shorten  the 
duration  of  the  treatment  or  to  lessen  its  severity.  One  val- 
uable feature  of  massage  and  movements  is  that  the  dose 
can  be  adapted  to  even  the  weakest  and  most  sensitive  pa- 
tient. Mechano-therapeutic  methods  should  not  be  applied 
while  the  stomach  is  full.  Their  effect  might  interfere  with 
the  function  of  the  stomach,  by  drawing  blood  away  from 
it  and  thus  impairing  its  digestive  power.  The  operator 
should  keep  the  anatomical  structure  and  the  physiological 
function  of  the  different  parts  of  the  organism  in  his  mind. 
In  adapting  the  Swedish  movements  to  the  condition  of  an 
individual  patient,  the  habits  and  mode  of  living  of  the  pa- 
tient should  be  inquired  into.  A  clerk,  for  instance,  who 
leads  a  sedentary  life,  needs  Swedish  movements  applied 
to  every  part  of  his  body  as  a  substitute  for  exercise.  A 
letter-carrier,  who  is  constantly  using  his  lower  extremities 
might  be  in  need  of  a  proportionate  amount  of  exercise  ap- 
plied to  the  muscles  of  his  back,  chest  or  arms.  In  all  these 


132  MODERN  PHYSIO-THERAPY. 

cases  experience  should  shape  the  judgment  of  the  operator 
in  adapting  means  to  the  end  and  individualizing  the  cases. 
[N.  B. — For  special  forms  of  mechano-therapeutic  ap- 
plications (notably  the  Nauheim  Method  in  diseases  of  the 
heart)  the  reader  is  referred  to  the  Therapeutic  Index.] 

Instrumental  Massage  and  Instrumental  Movements. 

While  there  is  no  doubt  that  the  human  hand,  if  en- 
dowed with  the  necessary  skill  and  guided  by  intelligence,  is 
the  most  perfect  instrument,  it  is  often  necessary  to  sub- 
stitute mechanical  appliances  for  the  trained  hand,  espe- 
cially when  patients  are  treating  themselves  at  home  under 
the  direction  of  the  physician  and  in  large  institutions  where 
there  is  a  great  deal  of  mechano-therapeutic  work  done. 

Instruments  have  been  devised  for  the  purpose  of  ad- 
ministering the  different  forms  of  massage,  especially  effleur- 
age  and  tapotement.  These  instruments  (massage-rollers, 
massage-balls,  massage-hammers,  etc.)  are  supposed  to 
be  held  and  guided  by  the  hands  of  the  operator.  In  the 
simple  forms  of  stroking  and  percussion  they  answer  very 
well.  Where,  however,  the  iactus  eruditus  is  necessary  to 
itveal  the  local  condition  and  its  peculiarities,  these  instru- 
ments are,  of  course,  practically  worthless.  On  general 
principles  their  value  has  been  overestimated  by  the  laity. 
They  can  never  supplant  the  hand  of  the  trained  masseur 
and  are  likely  to  do  more  harm  than  good  on  account  of  the 
ever-present  temptation  to  use  them.  Only  the  physician 
can  estimate  the  effect  of  the  massage-instrument  and  the 
range  of  its  proper  use.  On  general  principles,  I  believe 
that  a  vast  amount  of  harm  has  been  done  by  the  misuse  and 
overuse  of  these  appliances.  The  multiple  ball-roller  (small 
Uii'ls  on  a  cord),  held  by  both  hands  of  the  patient  and 
drawn  across  the  abdomen,  is  useful  in  encouraging  the  ab- 
sorption of  surplus  adipose  tissue  in  the  abdominal  wall. 
The  cannon-ball  as  a  massage-instrument  in  the  treatment  of 
constipation  enjoys  well-merited  popularity.  One  point  in 
its  favor  is  that  it  frequently  does  good  while  it  hardly  ever 


134  MODKK.N   PHYSIO-THERAPY, 

does  any  harm.  A  splendid  feature  of  many  of  these  me- 
chanical massage-devices  is  their  adaptability  to  the  use  of 
electricity  in  conjunction  with  massage.  Galvanism  and 
faradism  can  be  combined  with  their  use  if  they  are  properly 
constructed  to  serve  as  conductors  of  electricity. 

Of  much  greater  importance  than  the  massage  instru- 
ments are  the  mechanical  devices  for  the  administration  of 
movements  and  gymnastic  therapy.  The  use  of  these  ap- 
pliances for  therapeutic  purposes  will  always  be  associated 
with  the  name  of  Dr.  Gustav  Zander,  a  Swedish  physician, 
w-hose  set  of  Swedish-movement-machines  are  a  monument 
to  his  mechanical  genius  which  was  only  equaled  by  his 
splendid  skill  as  a  physician.  Zander  classifies  his  machines 
under  four  different  heads,  to  wit : 

1.  Machines    for   active   movements.      There   are   alto- 
gether thirty-eight  of  these  machines  intended  respectively 
for  the  upper  and  the  lower  extremities,  movements  of  the 
trunk  and  machines  for  balancing ; 

2.  Machines  for  vibration,  pressure,  tapotement,  petris- 
sage  and  effieurage.     There  are  thirteen  machines  of  this 
kind; 

3.  Five  machines  for  passive  movements; 

4.  Ten  orthopedic  machines,  mostly  for  curvatures  of 
the  spine. 

These  machines  are  wonders  of  mechanical  construction. 
They  are  accurately  adapted  to  their  purpose  and  are  ca- 
pable of  the  finest  adjustment  of  speed,  energy,  etc.  Most 
of  them  are  operated  by  electric  motors. 

The  employment  of  complicated  and  expensive  apparatus 
of  this  kind  is  necessarily  restricted  to  very  large  institu- 
tions. The  physician  who  wishes  to  add  the  movement-cure 
to  his  therapeutic  armamentarium  will  have  to  confine  him- 
self to  the  use  of  simpler  and  less  pretentious  devices.  Quite 
a  number  of  these  have  been  placed  on  the  market  and  arc 
easily  obtainable.  Home-made  machines  of  primitive  con- 
struction frequently  render  excellent  service.  A  familiar 
example  is  the  iron  ball  which  is  suspended  by  a  rope.  The 


MECHANO-THERAPY. 


135 


rope  runs  in  the  groove  of  a  pulley  which  is  mounted  four  or 
five  feet  above  the  ground.  The  patient  has  hold  of  the 
other  end  of  the  rope.  With  a  little  mechanical  ingenuity 
on  the  part  of  the  operator,  this  improvised  Swedish-move- 
ment-machine can  be  adjusted  in  such  a  way  as  to  give  any 
number  of  movements.  By  holding  the  rope  in  his  hand, 
by  attaching  it  to  his  foot,  by  placing  it  around  his  chest  or 


A.    CYCLE  FOR  INDOOR  EXERCISE.     B.    APPARATUS  FOR  EXERCISING  THE 

UPPER  PARTS  OF  THE  BODY. 
The  dial  indicates  the  exact  amount  of  work  done. 


his  abdomen  and  then  making  traction  on  the  rope,  the  pa- 
tient can  give- almost  ever}-  part  of  his  body  mechanical  treat- 
ment. He  can  vary  the  technique  and  the  effect  by  stand- 
ing, kneeling,  lying  or  sitting  on  the  floor  or  on  a  table,  and 
by  using  different  sizes  of  counter-weight.  I  have  a  distinct 
recollection  of  one  case  of  incipient  phthisis  that  received 
untold  benefit  from  a  primitive  arrangement  of  this  kind. 


136  MODERN  PHYSIO-THERAPY. 

The  importance  of  good  judgment  on  the  part  of  the  physi- 
cian must  again  be  emphasized.  The  danger  lies  in  over- 
doing things,  especially  at  the  start.  The  patient's  organ- 
ism, especially  the  heart,  must  be  educated  by  steady  and 
careful  training,  first  to  become  tolerant  to  exercise  of  this 
kind,  and  secondly  to  gain  strength  functionally  and  struc- 
turally while  apparently  sacrificing  energy. 

Vibration. 

Vibration  (from  the  Latin  ribrare,  to  tremble)  in  its 
finest  form  is  the  manner  in  which  all  force  in  nature  be- 
comes manifest.  Matter  proclaims  its  existence  through 
force-manifestations.  The  latter  are,  in  and  of  themselves, 
only  varieties  of  vibratory  movements.  Sound  is  vibration, 
light  is  vibration,  electricity  is  vibration,  organic  function  is 
vibration,  nerve-energy  is  vibration,  thought  is  vibration, 
life  itself  is  vibration.  There  is  no  life  without  force,  no 
force  without  vibration.  Vibration  is  the  elementary  basis 
of  all  biology. 

Vibration  in  its  coarse  form  means  the  act  of  imparting 
a  more  or  less  intense  trembling  motion  to  an  object,  e.  g. 
the  tissues  of  the  human  organism.  In  the  application  of 
manual  therapy  the  practice  of  manual  vibration  was,  up  to 
within  a  comparatively  recent  period,  considered  of  much 
importance.  Masseurs  cultivated  marvelous  skill  in  adminis- 
tering digital  or  manual  vibration.  Since  the  introduction 
of  the  mechanical  device  known  as  the  vibrator,  the  practice 
of  vibration  by  hand  has  become  almost  absolete.  The  vibrator 
performs  the  act  of  vibration  so  much  more  perfectly  and 
conveniently  that  manual  or  digital  vibration  can  well  be 
ignored  in  a  discussion  of  the  subject  of  vibration.  The 
vibrator  needs  no  introduction  or  recommendation.  Vibra- 
tion has  without  a  doubt  become  more  popular  than  any  of 
the  mechano-therapeutic  modes  of  application.  From  the 
exalted  plane  of  the  scientific  physio-therapist  down  to  the 
more  commercial  level  of  the  progressive  tonsorial  artist, 
vibration  enjoys  an  undisputed  degree  of  popularity.  The 


MECHANO-THERAPY.  137 

genius  of  the  American  mechanic  and  manufacturer  has 
made  its  employment  simple  and  agreeable.  Patients  are 
being  vibrated  for  every  ill  to  which  human  flesh  is  heir. 
That  the  universal  practice  of  vibration  should  involve  a 
great  deal  of  amateurish  empiricism,  is  not  surprising. 
Like  all  fads  in  medicine  it  is  "being  worked  to  death."  The 
attempts  which  have  been  made  by  some  manufacturing  con- 
cerns to  make  vibration  a  complete  system  of  medical  prac- 
tice and,  under  the  cover  of  a  great  deal  of  pseudo-scientific 
literature,  sell  a  good  many  vibrators  at  exorbitant  prices, 
have  injured  the  cause  of  vibration  as  a  therapeutic  agent. 
The  success  of  osteopathy,  more  than  any  other  factor,  sug- 
gested this  systematizing  of  vibration  as  a  cure-all,  the 
vibrator  taking  the  place  of  the  osteopathic  operator's  hand. 

There  are  many  good  vibrators  on  the  market.  If  the 
'mechanical  construction  of  a  vibrator  is  such  as  to  impart 
the  vibratory  impulse  to  the  tissues  of  the  patient  and  not  to 
the  hand  of  the  operator,  it  is  a  point  in  its  favor.  There  is 
no  doubt  that  the  vibrator  is  a  therapeutic  agent  of  great 
potency.  Its  use  should,  therefore,  be  preceded  by  an  ap- 
proximately correct  conception  of  its  possibilities,  physiolog- 
ically and  therapeutically.  The  modern  instrument  used  for 
generating  and  imparting  vibration  is  usually  operated  by  an 
electric  motor.  Considered  in  conjunction  with  the  instru- 
ment which  produces  it,  vibration  is  in  reality  but  a  succes- 
sion of  strokes  which  follow  each  other  more  or  less  rapidly. 
These  strokes  may  be  long  or  short,  severe  or  faint,  and  de- 
termine the  depth  of  the  vibratory  impulse  on  the  tissues. 
In  response  to  these  strokes  every  molecule  within  the  sphere 
of  the  vibratory  impulse  trembles,  the  intensity  of  the  re- 
sponse depending  on  the  relative  distance  from  the  source 
of  the  vibratory  movement.  This,  then,  is  vibration.  What 
is  its  physiological  and  therapeutic  effect  when  applied  to  the 
tissues  of  the  living  organism  ? 

As  has  been  stated  before,  the  simplest  and  most  ele- 
mentary form  of  a  stimulus  is  contact.  Any  organic  sub- 
stance which  is  at  all  capable  of  being  stimulated,  will  re- 


138  MODERN  PHYSIO-THKRAI-Y. 

spond  to  mere  contact  with  any  object.  Ciliary  motion, 
amoeboid  movement,  etc.,  are  stimulated  by  mere  contact. 
Stimulation  is  more  powerful  if  contact  becomes  more  firm. 
In  this  case  contact  would  be  in  the  nature  of  pressure.  If 
pressure  is  sudden  and  abrupt,  we  would  call  it  a  stroke  or 
a  blow.  A  succession  of  strokes  would  be  vibration.  Thus 
we  are  prepared  to  look  upon  vibration  as  being  primarily  a 
stimulus.  It  is  a  stimulus,  using  the  latter  word  in  the  same 
sense  in  which  we  applied  it  to  massage.  It  increases,  quan- 
titatively and  qualitatively,  the  local  circulation.  It  tones  up 
the  arterial  coats,  and  by  increasing  the  arterial  circulation 
and  thus  improving  the  nutrition  of  the  part,  it  stimulates 
excretion  and  absorption  of  waste-products  and  corrects 
metabolism.  The  pulse  becomes  fuller  and  slower.  \Ve 
can  readily  understand  why  it  is  indicated  in  passive  con- 
gestion, especially  when  pain  is  present  (torticollis,  chronic 
rheumatism,  lumbago,  neuralgia,  etc.).  It  causes  disintegra- 
tion and  absorption  of  low  forms  of  tissue  (obesity)  and 
stimulates  the  heart,  if  directly  applied  to  the  precordial  re- 
gion. It  stimulates  activity  by  increasing  the  tone  of  mus- 
cular structure  (constipation).  Its  local  physiological  ef- 
fect corresponds  accurately  to  that  of  massage.  For  this 
reason  the  term  "vibratory  massage"  is  entirely  proper  and 
adequate.  Vibration  and  manual  massage  form  a  very  ex- 
cellent therapeutic  combination. 

The  use  of  vibration  as  a  species  of  local  massage  and 
the  adaptation  of  the  osteopathic  idea  of  reaching  the  differ- 
ent parts  of  the  body  through  the  central  nervous  system 
(spinal  cord),  has  given  rise  to  the  division  of  vibration 
into  two  varieties,  i.  e.  peripheral  (local)  and  central  vi- 
bration. 

If  the  vibrator  is  applied  to  an  aching  part,  for  instance 
to  the  muscles  of  the  neck  in  a  case  of  torticollis  or  to  the 
muscles  of  the  back  in  a  case  of  lumbago  or  in  the  rectum 
for  the  cure  of  constipation  or  to  the  course  of  an  aching 
sciatic  nerve,  vibration  would  be  peripheral  or  local.  It 
resembles  the  local  application  of  massage.  Whatever  has 


MECHAXO-THERAPY.  139 

been  said  about  the  local  effect  of  t!ic  latter,  can  be  re- 
peated, in  a  measure,  concerning  the  local  action  of  vibra- 
tion. There  seems  to  be  no  doubt  that  its  primary  effect  is 
produced  on  the  peripheral  nerves,  the  vaso-motors,  and  that 
the  subsequent  local  phenomena  follow  in  physiological  se- 
quence. The  direction,  frequency  and  intensity  of  the  stroke 
must  not  be  lost  sight  of.  It  is  of  some  importance,  at  what 
angle  to  the  surface  the  vibratory  force  explodes,  what  de- 
gree of  energy  is  spent,  how  often  the  stroke  is  repeated, 
how  large  the  diameter  of  the  vibrated  area  is  and  how  much 
pressure  is  made  by  the  operator's  hand.  On  general  prin- 
ciples it  may  be  said  that  the  stimulating  effect  on  the  deep 
tissues,  e.  g.  the  deep  muscles  of  the  back  in  a  case  of  lum- 
bago, is  in  direct  proportion  to  the  relative  intensity  or  depth 
of  the  vibratory  stroke  and,  in  conjunction  therewith,  to 
the  relative  diameter  of  the  surface  treated.  Likewise  it 
can  be  stated  that  the  greatest  action  is  produced  by  a  down- 
ward stroke,  i.  e.  at  right  angles  to  the  surface.  The  lateral 
stroke,  i.  e.  parallel  to  the  surface,  stimulates  the  skin  and  its 
component  parts.  It  is  but  fair  to  state  that  while  all  these 
points  are  of  value  in  a  clinical  sense,  the  technique  of 
vibration  has  by  some  been  burdened  with  a  mass  of  detail 
altogether  out  of  proportion  to  the  relative  value  of  vibra- 
tion as  a  therapeutic  agent.  The  monomania  of  the  opti- 
mistic enthusiast  and  mercenary  instincts  of  the  overanx- 
ious manufacturer  who  insists  upon  making  a  complete  med- 
ical system  out  of  a  therapeutic  method,  are  equally  to 
blame.  The  former  lacks  exact  knowledge  and  the  latter 
conscience.  A  medical  subject  without  critical  knowledge  to 
purify  its  theory  and  conscience  to  sanctify  its  practice,  is 
indeed  a  miserable  make-believe. 

The  greatest  therapeutic  benefits  are  supposed  to  be 
derived  from  the  vibratory  stimulation  of  the  spinal  nerve- 
centers  whereby  peripheral  effects  are  produced  in  the  re- 
gions controlled  by  the  vibrated  centers.  This  is  the  form 
of  vibration  previously  referred  to  as  central  vibration. 
I  shall  endeavor  to  present  the  subject  in  keeping  with  the 


140  MODERN  PHYSIO-THERAPY. 

clinical  evidence  which  my  own  experience  and  that  of  other 
observers  has  adduced  in  support  of  this  attractive  form  of 
drugless  medication. 

Let  us  for  a  few  moments  recall  some  salient  points  con- 
cerning the  anatomy  and  physiology  of  the  spinal  cord  and 
its  adnexa.  The  spinal  cord  is  contained  in  the  vertebral 
canal,  the  latter  being  formed  by  the  so-called  spinal  fora- 
mina of  the  individual  superimposed  vertebrae.  The  cord 
lias  the  form  of  a  flattened  cylinder.  On  its  anterior  surface, 
in  the  median  line,  it  has  a  narrow,  deep  depression  known 
as  the  anterior  median  fissure.  On  its  posterior  surface  it 
has  the  posterior  median  fissure,  which,  however,  is  not  as 
deep  as  the  anterior.  On  either  side  of  the  anterior  median 
fissure  are  the  points  where  the  anterior  roots  of  the  spinal 
nerves  emerge.  The  posterior  roots  of  these  nerves  emerge 
on  either  side  of  the  posterior  median  fissure.  If,  in  a  cross- 
section  of  the  cord,  we  draw  imaginary  lines  from  the  points 
of  origin  of  the  anterior  nerves  to  the  points  of  the  origin 
of  the  posterior  nerves  on  the  opposite,  we  divide  the  cord 
into  four  distinct  sections,  which,  as  component  parts  of  the 
cord,  are  known  as  the  columns  of  the  spinal  cord.  There 
are  two  lateral,  an  anterior  and  a  posterior  column.  The 
bony  framework  which  surrounds  the  spinal  cord  is  com- 
posed of  the  so-called  vertebras  (seven  vertical,  twelve  dor- 
sal and  five  lumbar).  The  vertebrae  are  separated  from 
each  other  by  the  intervertebral  cartilages  and  are  placed  one 
above  the  other,  They  are  provided  with  foramina,  proc- 
esses, etc.,  for  the  accommodation  or  attachment  of  mus- 
cles, ligaments,  blood-vessels  and  nerves.  The  anterior  and 
posterior  roots  of  the  spinal  nerves  unite  and  emerge  through 
the  two  intervertebral  foramina,  and  supply  through  their 
numberless  ramifications  all  parts  of  the  body.  Before  the 
union  of  the  posterior  and  anterior  roots  of  the  spinal  nerves 
takes  place,  each  posterior  nerve  develops  a  so-called  gan- 
glion (a  knot-like  expansion  of  nerve-tissue,  largely  com- 
posed of  gray  matter),  which  is  of  oval  form,  of  reddish 
color,  and  is  located  near  the  inner  margin  of  the  interverte- 


MECHANO-THERAPY.  141 

bral  foramen.  These  ganglia  are  central  nervous  systems 
on  a  small  scale ;  they  are,  as  it  were,  sub-stations  of  nerve- 
tnergy.  The  physiology  of  the  spinal  nerves  rests  upon  the 
general  law  first  announced  by  Bell,  that  the  anterior  roots 
control  motion,  whereas  the  posterior  roots  control  sensa- 
tion. Xerves  that  communicate  with  each  other  form  what 
is  known  as  a  ple.rus.  It  is  of  great  clinical  value  to  remem- 
ber the  exact  location  of  the  more  important  nerve-ramifi- 
cations of  this  kind. 

Two  cords  of  nerve-tissue  extend  from  the  base  of  the 
skull  to  the  coccyx  symmetrically  on  each  side  of  the  ver- 
tebral column  in  front  of  the  so-called  lateral  processes. 
These  two  cords  are  studded  with  numerous  ganglia  which 
represent  distinct  centers  of  nerve-energy,  and  from  which 
and  to  which  branches  pass  in  diverse  directions.  These 
vertical  cords,  running  from  the  base  of  the  skull  to  the 
coccyx,  with  their  many  ganglia  and  branches,  are  what  is 
called  the  sympathetic  nervous  system.  Its  fibers  com- 
municate with  the  spinal  nerves,  supply  the  numerous  arter- 
ies nourishing  the  ganglia  and  pass  to  the  organs  of  the 
thorax,  abdomen  and  pelvis,  forming  many  important 
plexus. 

In  addition  to  the  motor  and  sensory  spinal  nerves  and 
the  ramifications  of  the  sympathetic,  there  are  some  of  the 
cranial  nerves  that  are  accessible  to  manipulation  after  they 
have  emerged  from  the  cranial  cavity  where  they  originate. 

The  fundamental  idea  of  all  osteopathic  and  central- 
vibratory  manipulations  is  to  preserve  or  restore  the  foun- 
tain-head of  all  life-energy,  i.  e.  the  roots  of  the  nerves  that 
control  all  evidence  of  vegetable  and  trophic  activity  in  the 
organism.  Such  preservation  or  restoration  consists  in 
regulating  the  nutrition  (circulation)  in  and  near  the  nerves, 
ganglia  and  plexus,  and  to  correct  deviations  from  the  nor- 
mal as  far  as  the  surroundings  of  these  nerves  are  con- 
cerned. All  disease  is  supposed  to  be  due  to  lack  or  per- 
version of  nutrition  of  these  nerve-structures  or  to  changes 
affecting  the  soft  and  hard  tissues  surrounding  them.  The 


142  MODERN  PHYSIO-THERAPY. 

vertebrae  may  be  in  faulty  apposition,  causing  the  interver- 
tebral  foramina  to  be  changed  in  size  and  contour.  This 
would  cause  pressure  on  the  structures  (vessels,  nerves) 
passing  through  these  openings.  The  result  would  be  evi- 
dence of  disease  in  the  part  or  parts  of  the  organism  which 
are  controlled  by  the  affected  nerves.  Anatomical  research 
has  revealed  the  frequency  of  deviations  from  the  normal 
anatomical  standard  of  the  spine.  From  the  number  of  ab- 
normal spines  it  would  almost  seem  as  though  the  normal 
spine  was  purely  a  theoretical  ideal.  This  fact  furnishes 
the  plausible  basis  for  a  system  of  pathology  that  recognizes 
no  disease  or  diseased  condition  except  inasmuch  as  it  is 
secondary  or  sequential  to  changes  in  or  near  the  spine 
and  its  adnexa.  The  fact  that  such  changes  might  give 
rise  to  peripheral  disturbances  and  that  removal  or  correc- 
tion of  the  central  lesion  might  sometimes  result  in  a  cure 
of  the  "disease,"  is  the  basis  of  osteopathy  and,  in  imitation 
thereof,  of  so-callecl  "vibratory  stimulation."  To  the  mind 
of  the  osteopathic  optimist  the  probability  assumes  the  hope- 
ful appearance  of  an  actuality  and  he  proceeds  to  erect  upon 
this  interesting  and  attractive  generalization  a  system  of 
medicine  as  complete  and  scientific  as  any  medical  mind 
could  wish  for.  It  would  all  be  well,  if  the  premises  were 
sound  and  logical.  That  the  osteopathic  pathology  explains 
much  that  we  never  dreamt  of  in  our  philosophy,  there  is  no 
doubt.  That  osteopathy  opened  up  a  neglected  field  of  clin- 
ical research,  can  not  be  denied.  That  osteopathic  manipu- 
lations frequently  produce  results  that  fairly  stagger  the 
drug-dispenser,  no  one  who  is  well  informed  will  attempt 
to  question.  But  it  is  likewise  true  that  osteopathy  is  a  gen- 
eralization from  limited  premises  and  that  it  is  bound  to 
fail  in  many  cases  because  the  principle  is  insufficient.  The 
same — cateris  paribus — holds  good  in  regard  to  systematic 
vibratory  stimulation. 

The  therapeutic  effect  to  be  produced  should  suggest  the 
technique  of  vibration.  From  previous  considerations  we 
know  that  mere  contact  is  the  simplest  form  of  stimulation. 


MECHANO-THERAPY.  143 

If  we  add  pressure  up  to  a  certain  degree  the  stimulating  ef- 
fect is  enhanced.  Continued  firm  pressure  finally  tires  a 
nerve  and  a  sedative  action  is  the  result.  If  we  continue 
firm  pressure  beyond  the  sedative  dose,  the  activity  of  the 
nerve  is  suspended,  i.  e.  inhibition  of  nerve-function  takes 
place.  Since  vibration  is  a  form  of  interrupted  pressure,  we 
may  reasonably  assume  that  effects  analogous  to  those  of 
continued  pressure  can  be  produced.  That  rhythmical  in- 
terruptions are  in  themselves  capable  of  exciting  nerve- 
action,  is  plain.  Thus,  we  may  summarize  the  effect  of 
central  vibrations  in  the  following  classification : 

1.  Mild  Stimulation  (very  short  strokes)  ; 

2.  Powerful  stimulation  (deep  strokes)  ; 

3.  Suspension   of  nerve-activity    from   overstimulation 
(long-continued  deep  vibration). 

CENTRAL  STIMULATION  is  a  subject  worth  investigating. 
We  are  still  at  the  threshold.  It  behooves  any  and  all  of  us 
to  investigate  carefully  and  help  in  the  elaboration  of  this 
new  and  promising  field  of  physio-therapeutic  work.  I  will 
attempt  to  give  the  general  landmarks  of  the  subject  as  far 
as  our  knowledge  of  neuro-physiology  and  actual  experi- 
ence in  central  vibration  justify  any  statements. 

Theoretically,  the  idea  of  acting  upon  pathological  con- 
ditions through  the  central  nervous  system  or,  to  be  more 
correct  and  explicit,  through  the  sympathetic  nervous  sys- 
tem is  in  perfect  harmony  with  the  pathological  view  which 
looks  upon  all  diseased  conditions  as  being  either  due  to 
over-nutrition  (hypertrophy,  inflammation,  catarrh),  un- 
der-nutrition  (atrophy,  degeneration),  or  perverted  nutri- 
tion (ischemia,  toxemia  in  the  widest  sense,  abnormal  cell- 
formation).  At  all  events,  the  essence  of  disease  is  thought 
to  be  some  disturbance  of  local  or  general  nutrition.  Since, 
however,  nutrition  is  practically  synonymous  with  blood- 
circulation,  the  idea  of  controlling  (increasing,  decreasing, 
altering)  local  nutrition  resolves  itself  practically  into  the 
idea  of  controlling  (stimulating,  depressing,  changing)  the 
circulation  in  an  affected  region.  The  sympathetic  nervous 


144  MODERN  PHYSIO-THERAPV. 

system  is,  to  all  intents  and  purposes,  the  auditing  office  of 
the  commissary  department  of  the  organism.  It  controls 
the  supplies  furnished  to  the  different  parts  of  the  body., 
The  sympathetic  ganglia  and  plexus  represent  chiefs  in 
charge  of  the  supplies  of  special  departments.  These  heads 
or  chiefs  have  clerks  under  their  control  who  look  after  the 
supplies  of  small  portions  of  the  region  superintended  by 
the  chief.  For  example :  The  sympathetic  plexus  that  con- 
trols the  nutrition  of  (circulation  in)  all  the  abdominal 
viscera  is  known  as  the  solar  plexus.  From  it  are  derived 
ten  smaller  nerve-plexus,  known  as  the  phrenic,  cceliac,  gas- 
tric, hepatic,  splenic,  supra-renal,  renal,  superior  mesenteric, 
inferior  mesenteric  and  spermatic  plexus,  whose  sphere  of 
control  is  suggested  by  their  names.  To  stimulate  the  solar 
plexus  means  to  increase  the  nutrition  of  (circulation  in) 
all  the  abdominal  organs.  The  synonymous  character  of 
"circulation"  and  "nutrition"  is  suggested  by  the  terms 
"vaso-motor"  and  "trophic,"  which  are  likewise  synony- 
mous and  refer  to  the  sympathetic  nervous  system.  The 
"vaso-motor"  nerves  are  the  "trophic"  nerves.  Both  names 
are  interchangeable  with  "sympathetic"  nerves. 

The  function  of  the  motor  and  sensory  nerves  is  con- 
trolled by  the  sympathetic  nervous  system.  The  degree  of 
their  functional  capacity  is  determined  by  the  nutrition  of 
their  fibers  and  ganglia.  Mai-nutrition  of  motor  and  sen- 
sory nerves  means  corresponding  impairment  of  motion  and 
sensation  in  the  areas  supplied  by  them.  Destruction  of 
these  nerves  means  suspension  of  motion  and  sensation. 
The  lymphatic  vessels  and  glands,  the  heart,  the  lungs,  the 
skin,  in  fact  any  and  every  part  of  the  organism  is  con- 
trolled by  and,  therefore,  can  be  reached  and  acted  upon 
through  the  nervous  system.  This  is  the  basic  theory  of 
central  vibration.  For  the  practical  application  of  the  prin- 
ciples involved  the  following  classification  of  spinal  centers 
or  regions  might  be  of  some  service. 

Vibration  over  the  cervical  vertebra  (in  the  median 
line  or  on  either  side  of  the  median  line  in  the  intervertebral 


A I  ECU  A. \O~THERAPY.  145 

spaces)  is  capable  of  causing  impulses  to  be  communicated 
to  the  motor,  sensory  and  vaso-motor  nerves  supplying  the 
head,  neck,  arms  and  of  the  body  as  far  down  as  the  dia- 
phragm. It  will  be  remembered  that  the  cervical  plexus  is 
formed  by  the  anterior  divisions  of  the  four  upper  cervical 
nerves,  the  brachial  plexus  by  those  of  the  lower  four.  In 
the  sympathetic  nerve-supply  of  the  neck  are  some  of  the 
most  important  centers  and  ganglia,  controlling  (stimulat- 
ing, inhibiting)  the  blood-supply  (nutrition)  of  the  head 
and  brain.  Respiration  and  the  function  of  the  heart  can 
be  influenced  through  vibration  in  this  region.  At  the  sides 
of  the  neck  the  phrenic  nerve  (coming  from  the  cervical 
plexus  and  supplying  the  diaphragm)  and  the  vagus  (from 
the  eighth  pair  of  cranial  nerves)  which  supply  motion  and 
sensation  to  the  organs  of  voice,  and  motion  to  the  pharynx, 
oesophagus,  stomach  and  heart,  are  accessible  to  vibration. 

VIBRATION-TABLE;  FOR  CERVICAL  REGION. 

Circulation  (face,  head,  brain)  )  .  i.  to  6.  ^  vertebn£- 

(general)  )  ' 

Eye, i.  to  3.  "  " 

Heart   (muscular  tone), i.  to  5.  " 

"         (rhythm), 2.  to  4.  " 

Ear, 6.  to  7.  "  " 

Organs  of  voice  (larynx  etc.), i.  to  3.  " 

Mechanism  of  respiration, 3.  to  5.  " 

Thermic  centers,  , 2.  to  5.  " 

Glands  (lower  jaw), 2.  to  3.  " 

Diaphragm, 3.  to  5.  " 

Plexus   (cervical), 2.  to  4.  " 

"         (brachial) 5.  to  7.  " 

There  are  twelve  dorsal  vertebra".  They  practically  rep- 
resent the  location  of  sympathetic  centers  and  ganglia  which 
control  the  functions  of  the  organs  of  digestion  and  assimi- 
lation. It  is  through  vibration  along  this  region  that  we 
can  influence  the  splanchnic  nerves  and  above  all  the  great 
solar  plexus.  In  moderately  well-nourished  or  thin  per- 
sons, vibration  through  the  abdominal  wall  is  capable  of 


146  MODERN   PHYSIO-THERAPY. 

affecting  the  nerve-tissue  of  the  solar  plexus  and  its 
branches.  The  motor  nerves  of  the  lower  extremities  orig- 
inate in  the  dorsal  region.  We  must  not  lose  sight  of  the 
fact  that  the  fine  interlacement  of  nerve-fibers  establishes 
many  direct  paths  toward  distant  nerve-centers  and  ganglia, 
so  that  many  subsidiary  ganglia  are  found  in  the  dorsal  re- 
gion that  are  connected  with  the  important  ganglia  in  the 
cervical  region  and,  as  it  were,  serve  as  sub-stations.  Thus 
we  find  quite  a  few  sub-ganglia  from  the  second  to  the 
seventh  dorsal  vertebrae  that  share  in  the  control  of  the 
mechanism  of  respiration. 

VIBRATION-TABLE  FOR  THE  DORSAL  REGION. 

Stomach, 3.  to  12.  dorsal  vertebrae. 

Relaxation  of  pylorus, 4.  to    5.  " 

Liver, 9.  to  12.  " 

Pancreas, 8.  to    9.  " 

Spleen, 8.  to  n.  "  " 

Intestines  (small), I.  to  10.  " 

Peristalsis 9.  to  n.  " 

Chill-centers  (connected  with  thermic  ganglia)s  .    .  7.  to    8.  " 

Kidneys, 6.  to  12.  " 

Diaphragm  (through  phrenic  fibers  of  solar  plexus),  .  n.  to  12.  " 

Lymph-circulation  (through  splanchnic  nerves),  .    5.1012.  " 

Lower  extremities 2.  to  12.  " 

The  remainder  of  the  vertebral  column  is  made  up  of 
five  lumbar  vertebra,  the  sacrum  and  coccyx.  The  nerve- 
ganglia  and  plexus  in  this  region  control  principally  the 
functions  of  the  large  intestines  and  of  the  genito-urinary 
apparatus.  An  important  thermic  sub-ganglion  is  situated 
near  the  fifth  lumbar  vertebra.  The  nerve-centers  con- 
trolling the  sexual  function  in  both  sexes  are  distributed 
over  the  whole  lumbar  region  and  are  closely  connected  with 
similar  centers  situated  near  the  three  lower  dorsal  verte- 
brae. It  is  of  interest  and  importance  to  remember  the  uni- 
versal distribution  of  ramifications  of  nerve-fibers  which 
directly  and  indirectly  connect  with  the  sex-centers  and  are 
closelv  interwoven  with  the  nerves  of  the  skin.  It  is  well 


MECHANO-THERAPY.  147 

known  that  the  sex-centers  can  be  powerfully  stimulated 
through  the  skin.  Therein  lies  the  physiology  of  the 
caresses  and  strokings  which  are  so  closely  connected  with 
the  awakening  of  the  sexual  appetite.  Many  forms  of  sex- 
ual perversion  can  be  thus  explained,  e.  g.  the  flagellations 
of  some  religious  individuals  in  the  Middle  Ages,  who  sub- 
stituted the  erotic  sensations  produced  by  this  form  of  vio- 
lent skin-stimulation  for  the  sinful  pleasures  of  the  sexual 
act. 

VIBRATION-TABLE;  FOR  THS  LUMBAR  REGION. 

Intestines  (large), I.  to  4.  lumbar  vertebrae. 

Mechanism  of  micturition, I.  to  2.  " 

Sexual  desire,    .- 2.  "  • 

Sexual  mechanism, i.  to  5.  "              " 

Kidneys, •  .  I.  to  3.  "              " 

Menstrual  function, 2.  to  5.  "              " 

(also  8.  to  10.  dorsal  vertebrae.) 

Central  vibration  should  always  be  supplemented  by  vi- 
bration of  the  periphery.  Thus  after  stimulating  the  small 
and  large  intestines  centrally,  the  operator  should  apply  the 
vibrator  through  the  abdominal  wall  to  the  small  intestines, 
then  to  the  large  gut  and  finally  introduce  a  suitable  at- 
tachment and  practice  rectal  vibration.  Another  example 
would  be  the  application  of  vibration  over  the  cervical  ver- 
tebrae, and  afterwards  in  the  precordial  region,  for  the  re- 
lief of  certain  conditions  of  the  heart. 

The  lymphatics  (the  sewrers  of  the  body)  are  reached 
peripherally.  Vibration  over  the  lymphatic  glands  and 
along  the  course  of  the  lymph-flow  stimulates  excretion 
through  these  lymph-canals.  Thus  drainage  of  the  arm  may 
be  accomplished  through  stimulation  of  the  axillary 
lymphatics,  drainage  of  the  leg  through  stimulation  of  those 
in  the  region  of  Poupart's  ligament,  etc.  In  order  to  prac- 
tice this  form  of  medication  it  behooves  the  operator  to  re- 
freshen his  memory  by  an  occasional  reference  to  some 
good  text-book  on  anatomy.  (Also  see  vibration-tables  un- 
der PARALYSIS — Part  II  of  the  book.) 


148 


MODERN  PHYSIO-THERAPY. 


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MECHAXO-THERAPY.  149 

Oscillation. 

Oscillation  in  variable  degrees  of  intensity  is  practiced 
manually  by  masseurs.  It  is  really  an  exaggerated  form  of 
vibration.  It  means  a  violent  shaking  up  of  a  part,  e.  g. 
the  abdomen,  by  the  hand  of  the  operator.  Oscillation  is 
nowadays  practiced  with  the  aid  of  a  specially  constructed 
instrument,  called  an  "oscillator."  The  physiological  effect 
and  therapeutic  indications  are  similar  to  those  of  other 
forms  of  mechano-therapy,  notably  Swedish  movements  and 
peripheral  vibration.  It  manipulates  the  tissues  en  masse 
by  a  violent  and  indiscriminate  shaking  up.  It  is  an  excel- 
lent muscular  tonic  and  can  be  frequently  employed  with 
advantage  in  breaking  up  adhesions  and  stretching  con- 
tractured  tissues.  Oscillation  of  the  whole  abdomen  is  a 
splendid  auxiliary  in  the  treatment  of  habitual  constipation. 
A  thorough  understanding  of  the  principles  of  massage  and 
vibration  will  enable  the  operator  to  employ  oscillation  at 
the  proper  time  and  in  the  proper  way. 

In  conclusion  let  me  again  say  that  the  possession  of  a 
vibrating  or  oscillating  instrument  should  not  be  a  reason 
for  employing  vibration  and  oscillation  indiscriminately  in 
each  and  every  case.  Never  lose  sight  of  the  indications  in 
each  case  and  the  limitations  to  the  use  of  vibration  and 
oscillation.  Beware  lest  you  become  a  fanatic  in  theory 
and  a  buffoon  in  practice.  Always  try  to  comprehend  the 
purpose,  to  understand  the  means,  and  to  adapt  the  latter  to 
the  former  intelligently.  Quidquid  agis,  prudenter  agas  et 
respice  finem! 


150  MODERN  PHYSIO-THERAPY. 


CHAPTER  VI. 
FORCE  AND  FORCE-MODALITIES. 

Tug  true  student  of  nature  is  not  satisfied  to  merely  ob- 
serve the  phenomena  of  activity  around  and  within  him. 
He  inquires  into  the  reasons  of  things  and  tries  to  establish 
the  connection  between  causes  and  effects.  In  attempting 
to  do  so  he  is  obliged  to  analyze  the  manifestations  of  ac- 
tivity and  find  the  laws  which  govern  them  and  the  man- 
ner in  which  these  laws  operate.  He  knows  that  nature 
represents  the  sum-total  of  the  things  that  are.  He  is 
aware  that  these  things  possess  certain  properties  which 
determine  and  influence  their  relations  to  their  surroundings, 
and  that  these  properties  are  the  manifestations  of  force  in- 
herent in  the  things  that  are.  He  knows  that  the  things  that 
are,  represent  matter  in  different  states  of  aggregation  and 
composition  and  necessarily  possess  inherent  energy.  To 
.him  existence  means  the  mutual  relation  of  matter  and  force. 
Thus  the  study  of  this  relation  is  in  reality  the  very  essence 
of  natural  philosophy. 

That  which  we  call  "light"  is  an  evidence  of  some  ac- 
tivity. The  energy  inherent  in  that  compound  of  matter 
which  we  call  "sun"  becomes  manifest  and  is  perceived  by 
that  compound  of  matter  which  we  call  "organ  of  sight." 
This  evidence  of  activity  begins  and  ends  with  a  manifesta- 
tion of  energy  inherent  in  matter.  The  two  compounds  of 
matter  assume  a  certain  relation  to  each  other.  This  re- 
lation must  affect  other  existing  things  which  are  inter- 
posed between  one  compound  and  the  other,  between  the 
sun  and  the  eye.  This  relation  is  real,  not  a  figment  of  the 
mind,  not  an  illusion.  That  which  is  interposed  between 


FORCE  AND  FORCE  MODALITIES.  151 

two  compounds  of  matter  must  likewise  exist  and  must 
therefore,  be  matter.  If  it  were  not,  it  would  be  non-exist- 
ent. This  would  be  absurd.  It  may  be  air,  it  may  be  gas. 
It  must  be  matter  of  some  kind.  For  the  purpose  of  giving 
a  name  to  matter  in  its  simplest  non-classifiable  form,  not 
any  special  kind  of  matter,  but  matter  pure  and  simple,  the 
term  "ether"  is  used  by  physicists.  Space  would  be  a  vague, 
meaningless  abstraction  unless  we  imagine  it  filled  with  a 
universally  present,  imponderable  substance  of  some  kind 
which  represents  existence  pure  and  simple,  /'.  e.  matter  in 
its  simplest  and  most  elementary  form.  It  makes  space  an 
actuality  and  gives  to  force-manifestations  a  medium  of 
transmission.  It  is  the  carrier  of  the  force-manifestations. 

Inasmuch  as  ether  makes  space  a  physical  reality,  it  is 
divisible  in  the  same  sense  in  which  distance  between  two 
things  is  divisible.  We  can  imagine  the  distance  to  be 
divided  into  two,  five,  ten,  fifty,  a  hundred,  a  thousand,  a 
million  parts.  This  would  mean  a  division  of  the  quantity 
of  ether.  There  would  necessarily  be  a  physical  limit  to 
division.  The  smallest  imaginable  particle  of  ether  is  the 
molecule  of  ether  or  ethereal  molecule.  If  ether  en  masse 
receives  and  transmits  force-manifestations,  the  ethereal 
molecule  must  necessarily  do  so  because  it  is  what  in  the 
aggregate  constitutes  ether.  We,  therefore,  look  upon  the 
ethereal  molecule  as  being  the  real  carrier  of  force-mani- 
festations. The  only  conceivable  mode  of  transmission  is 
more  or  less  rapid  motion  of  the  molecule.  It  changes  its 
relation  to  the  neighboring  molecules  which  receive  the  im- 
petus and  also  react  upon  it  by  motion.  The  rapid  motion 
of  the  molecule  is  known  as  vibration  or  oscillation  of  the 
ethereal  molecule.  We  can  imagine  an  impetus  to  engage  a 
whole  series  of  molecules  and  be  thus  transmitted  to  the 
next  series.  From  their  resemblance  to  the  motion  of  waves 
this  form  of  serial  motion  has  been  called  undulation. 

We  are  prepared  to  look  upon  force  as  a  necessary  prop- 
erty of  matter.  It  is  its  inherent  energy  which  is  capable 
of  causing  ethereal  oscillations  and  undulations,  the  latter 


152  MODERN  PHYSIO-THERAPY. 

being  its  mode  of  transmission.  There  is  no  limit  to  the 
variety  of  oscillatory  and  undulatory  motion  of  the  ethereal 
molecules.  The  oscillatory  movement  may  be  more  or  less 
rapid,  may  be  fine  or  coarse.  The  undulations  may  be 
slight  or  well-marked,  may  be  long  or  short.  This  gives  us 
the  concept  of  wave-length  or  the  length  of  the  series  of 
molecules  which  is  set  in  motion  by  an  impetus  before  the 
latter  is  received  by  the  next  series. 

It  is  this  variation  of  ethereal  oscillation  and  undulation 
which  modifies  the  manifestations  of  inherent,  crude,  ele- 
mentary force  and  gives  them  the  specific  character  of  light, 
sound,  electricity,  heat,  etc.,  etc.  All  these  manifestations 
of  activity  transmitted  by  the  ethereal  molecules  are  modali- 
ties of  the  original  elementary  force.  In  this  sense  we  speak 
of  light,  sound,  etc.,  as  being  force-modalities.  They  are 
not  forces  but  modalities  of  the  same  elementary  force,  the 
modifying  element  being  the  motion  of  the  ether  molecularly 
and  serially.  This  conception  of  force  and  force-manifesta- 
tion furnishes  the  only  plausible  explanation  of  the  phe- 
nomena of  light,  sound,  heat,  electricity,  radio-activity,  mag- 
netism, animal  magnetism  and  suggestion.  It  brings  these 
diverse  forms  of  activity  under  the  general  head  of  force- 
modalities. 

The  modus  operandi  of  force-transmission  is  easily  un- 
derstood. The  impetus  which  emanates  from  matter  in  the 
form  of  a  manifestation  of  energy  is  carried  from  molecule 
to  molecule,  from  series  of  molecules  to  series  of  molecules, 
the  manner  of  molecular  oscillations  and  serial  undulations 
giving  to  the  impetus  a  specific  character,  e.  g.  light,  sound. 
If  a  stone  is  dropped  into  water,  the  impetus  communicated 
to  the  body  of  water  will  be  seen  to  travel  through  the  lat- 
ter, giving  rise  to  circular  waves,  emanating  from  the  cen- 
ter and  traveling  towards  the  periphery.  A  cork  dropped 
into  the  water  will  not  be  carried  along  by  these  waves  (un- 
dulations), but  will  bob  up  and  down.  This  example  is  to 
illustrate  the  idea  of  force-transmission  through  a  medium 
which — as  a  whole — remains  stationary.  The  molecules  of 


FORCE  AND  FORCE  MODALITIES.  153 

water  move,  but  their  motion  is  a  vibration  or  oscillation 
around  their  normal  point  of  rest  as  a  center.  These  mole- 
cules move  and  gradually  return  to  their  position  of  rest. 
If  a  rope  is  suspended  and  the  lower  end  is  given  a  sudden 
jerk,  the  impetus  will  be  seen  to  travel  upward  in  the  form 
of  waves  formed  by  the  rope.  The  rope  is  relatively  sta- 
tionary. The  impetus  travels.  Vibration  of  the  molecule 
means  motion  around  a  given  point  of  rest.  Undulation  of 
z  series  means  motion  around  a  given  line  of  rest. 

Force  is  eternally  and  universally  one  and  the  same.  It 
only  differs  in  its  modalities.  Matter  can  likewise  be  con- 
sidered eternally  and  universally  one  and  the  same.  It  only 
differs  in  its  states  of  aggregation.  Ether  permeates  space, 
even  the  space  occupied  by  matter  whose  state  of  aggrega- 
tion is  such  as  to  be  perceptible  by  our  organs  of  sense,  e.  g. 
a  piece  of  lead  which  is  seen  and  felt.  The  state  of  molec- 
ular aggregation  of  matter  must  necessarily  affect  the  molec- 
ular ethereal  vibrations  within  it.  If  an  impetus  has  been 
received  and  is  being  transmitted  by  the  molecules  of  ether, 
the  vibrations  of  ethereal  molecules  can  not  help  being  im- 
peded to  a  certain  extent  by  the  gross  or  macroscopic  media 
which  the  ether  permeates,  e.  g.  air,  smoke,  wood,  metal  or 
imy  kind  of  matter  which  may  be  within  the  path  of  ethereal 
oscillations  and  undulations.  These  interposed  media  may 
serve  as  obstacles,  e.  g.  a  layer  of  lead  to  the  X-rays,  or  as 
conductors  of  force-transmission,  e,  g.  glass  as  a  conductor 
of  light,  copper  as  one  of  electricity.  The  physical  attributes 
of  matter  which  give  to  the  latter  its  power  of  conducting, 
altering,  intercepting  these  vibrations  are  not  clearly  under- 
stood, although,  as  suggested  before,  the  state  of  aggrega- 
tion of  matter  seems  to  give  to  the  latter  its  relative  fitness 
as  a  conducting  or  intercepting  medium  for  different  kinds 
of  force-modalities.  One  state  of  aggregation  may  not 
offer  any  resistance  to  one  form  of  molecular  vibration,  e.  g. 
a  piece  of  cloth  to  the  X-rays,  while  it  will  completely  arrest 
vibrations  of  another  kind,  e.  g.  vibrations  of  light  from  the 
solar  spectrum.  Certain  interposed  media  may  completely 


154  M(I|):-;R\    I  Mi  vsio-Tn  i-.R.M-y. 

stop  vibrations  of  sound,  e.  g.  a  brick  wall,  while  they  would 
not  interfere  at  ail  with  the  force-modality  emanating  from 
the  generator  of  a  wireless  telegraph-instrument.  These 
points  seem  trivial  upon  first  sight.  Closer  investigation 
will  reveal  their  importance  as  auxiliaries  in  the  solution  of 
many  an  occulr  physical  problem. 

"Force,"  says  Moleschott,  "is  the  necessary  property  of 
matter,  inseparable  from  the  latter  and  inherent  in  it  from 
the  very  beginning."  Matter  everywhere  is,  as  it  were, 
charged  with  it  and  constantly,  under  given  favorable  con- 
ditions, proves  the  presence  of  force.  Matter  possesses  at 
all  times  the  property  of  communicating  impulses  to  the 
ether  and  causing  these  impulses  to  be  carried  by  vibrating 
ethereal  molecules.  The  latter  give  rise  to  different  force- 
modalities.  The  change  of  elementary  force  into  a  special 
force-modality  and  the  change  of  one  modality  into  another 
are  generally  admitted  scientific  facts  (Kraftumwerthung). 
Thus  the  elements  of  one  modality  are  the  elements  of  every 
other  modality.  Magnetism  is  converted  into  electricity, 
into  X-ray  radiations,  into  light-phenomena,  into  heat  and 
so  on.  It  would  carry  me  beyond  the  confines  of  my  sub- 
ject to  refer,  even  in  a  brief  way,  to  the  physiological  pos- 
sibilities of  this  view  of  force  and  force-modalities.  That 
the  sum-total  of  energy  present  within  our  solar  system  is 
in  reality  reflected  sun-energy,  that  the  sun  is  the  original 
source  of  all  force,  is  not  altogether  improbable.  This  view 
would  furnish  a  modern  scientific  basis  for  the  ancient  sun- 
cult  of  Zoroaster.  It  would  be  in  accord  with  the  chron- 
ological events  of  the  creation  as  related  in  the  Genesis. 
The  first  act  of  creation  refers  to  the  sun  upon  whose  phys- 
ical activity  the  existence  of  all  other  things  depends.  From 
this  heliologic  point  of  view  the  energy  of  matter  is  reflected 
sun-energy  or  a^charge  received  and  re-supplied  by  the  ac- 
tivity of  the  sun  (helio-pantheism). 

Since  force  is  that  property  of  matter  by  which  matter 
keeps  the  ethereal  molecules  in  a  state  of  agitation  and  since 
matter  without  this  constantly  active  property  can  not  be 


FORCI:  AND  FORCE  MODALITIES.  155 

conceived,  we  are  prepared  to  consider  all  matter  necessarily 
in  a  state  of  radio-activity,  meaning  by  the  latter  term  the 
property  of  imparting  impulses  to  the  molecules  of  ether  by 
which  the  latter  are  made  to  oscillate  and  undulate.  The 
force-modalities  of  an  excited  X-ray  tube  or  of  radium  are 
coarse  illustrations  of  radio-activity.  There  is  no  doubt  that 
millions  and  millions  of  different  force-modalities  are  con- 
stantly active  without  us  and  within,  too  fine  for  our  coarse 
senses  and  means  of  investigation  to  discover.  We  have 
hardly  learned  the  alphabet  of  this  wonderful  subject.  We 
know  nothing  concerning  the  radio-activity  of  the  human 
body  and  of  every  molecule  within  it.  The  neuron  (nerve- 
cell)  is  radio-active  and  causes  impulses  to  be  communicated 
to  the  ethereal  molecules.  Within  the  range  of  this  ethereal 
oscillation  there  is  some  particle  of  matter,  some  nerve-cell, 
some  neuron  whose  state  of  aggregation  and  composition 
qualifies  it  to  respond  to  these  ethereal  oscillations,  just  as 
the  ear  responds  to  sound,  the  eye  to' light.  Thus  the  second 
neuron  vibrates  in  harmony  with  the  first.  What  more 
plausible  explanation  can  be  given  of  the  phenomena  of 
telepathy  and  suggestion?  What  else  can  thought  be  ex- 
cept a  form  of  radio-activity  of  brain-cells?  In  no  other 
way  can  mental  or  psychic  phenomena  ( memory,  conscious- 
ness, dreams,  etc.)  be  explained. 

It  can  no  longer  be  doubted  that  every  molecule  of  the 
human  body  possesses  some  form  of  radio-activity.  How 
many  different  forms  of  radio-activity  the  body  possesses, 
what  relative  degree  of  radio-active  force  is  present  in  dif- 
ferent molecules,  what  influences  may  affect  the  quantity 
or  quality  of  radio-activity,  whether  there  is  but  one  com- 
plete force  or  a  duality  of  forces  (positive,  negative),  what 
the  relations  of  these  dual  elements  are, — all  these  ques- 
tions are  open  and  will  remain  so  for  some  time  to  come. 
That  certain  radio-active  forces  exist  in  the  body  and  give 
rise  to  strange  phenomena,  is  admitted  on  all  sides.  Not 
very  long  ago  I  saw  a  radiograph  which  had  been  produced 
by  the  radiating  energy  from  the  hand  of  a  so-called  mag- 


156  MODERN  PHYSIO-THKRAPY. 

netic  operator.  The  photographic  sensitive  plate  was  placed 
in  a  black  and  yellow  envelope  and  put  on  a  table.  A  key 
was  deposited  on  the  outside  of  the  yellow  envelope.  For 
twenty  minutes  the  operator  held  his  hands  over  the  plate, 
the  tips  of  the  fingers  pointing  towards  the  key.  The  plate 
was  developed  in  the  ordinary  way  and  showed  a  faint  radio- 
graph of  the  key.  The  room  in  which  the  experiment  was 
made  was  dark.  The  magnetic  or  radio-active  force  ema- 
nating from  the  man's  hands  is  just  as  real  as  the  radio- 
activity of  an  X-ray  tube  or  of  radium.  I  dislike  the  word 
"animal  magnetism"  because  it  savors  of  charlatanism.  It  is 
not  an  illusion  or  a  deception,  however.  It  suggests  a  form 
of  physical  energy  which  we  are  unable  to  account  for,  al- 
though the  effects  of  its  activity  can  be  seen  everywhere. 
The  phenomena  of  individuality,  genius,  talent,  suggestion, 
hypnotism,  telepathy,  love,  passion,  maternal  or  pre-natal 
impressions,  heredity,  idiosyncrasy  and  temperament  must 
be  classified  under  this  head. 

For  the  sake  of  illustration  I  beg  to  quote  a  few  exam- 
ples without,  however,  attempting  to  classify  them  or  ac- 
count for  them.  A  sleeping  person  can  be  awakened  by 
some  one  looking  at  him  or  pointing  at  him  even  in  a  dark 
room.  Moll  reports  the  case  of  a  young  lady  who  had  lost 
over  twenty  pounds  in  weight  in  less  than  six  months. 
There  was  no  other  indication  of  anything  being  wrong. 
She  was  a  blonde  with  soulful  blue  eyes  and  a  most  amiable 
disposition.  Upon  inquiry  it  was  ascertained  that  for  six 
months  she  had  slept  with  her  younger  sister,  a  brunette 
with  snappy  black  eyes  and  a  very  positive  disposition.  The 
younger  sister  happened  to  be  sent  off  to  school  and  slowly 
but  surely  the  older  one  regained  her  weight.  Similar  cases, 
especially  among  married  people,  have  frequently  been  re- 
ported. Children  often  show  a  dislike  for  some  strange 
person,  there  being  no  apparent  reason  for  such  dislike. 
The  touch  or  the  handshake  of  some  people  is  distasteful. 
Even  the  lower  animals  are  affected  by  these  mysterious 
forces.  The  old  adage,  "Speak  of  the  devil  and  he  is  sure  to 
appear,"  has  reference  to  the  appearance  of  a  person  who 


FORCE  AND  FORCE  MODALITIES.  157 

is  just  being  spoken  of.  It  can  be  explained  on  the  basis  of 
ethereal  oscillations.  Presentiments,  premonition  and  the 
telepathic  influences  of  mind  over  mind  likewise  become  in- 
telligible if  explained  on  the  ground  of  radiation. 

That  the  body  radiates  heat,  is  plain.  That  it  has  a  phos- 
phorescence of  its  own  and  throws  out  rays  (n-rays)  re- 
sembling those  of  light,  is  believed  by  many.  The  influence 
of  rays  of  short  undulation  and  very  rapid  oscillation 
(ultra-violet  field  of  the  solar  spectrum)  on  the  sex  of  plants 
and  animals  is  a  strange  biological  phenomenon. 

What  bearing  has  this  theoretical  discussion  of  force 
and  force-modalities  on  the  practical  application  of  Physi- 
ological Therapeutics? 

In  order  to  understand  light,  electricity  and  other  phys- 
ical agents  and  their  relations  to  each  other,  it  is  necessary 
to  try  and  get  a  glimpse,  however  faint,  into  Nature's  work-  ' 
shop.  That  the  greatest  achievements  along  physical  and 
biological  lines  are  still  to  come,  there  seems  to  be  no  doubt. 
It  behooves  us  to  sharply  define  our  concepts  of  radio- 
activity and  its  place  in  nature  because  it  is  the  connecting 
link  between  matter  and  force,  as  we  are  at  this  late  day 
prepared  to  admit.  Suggestion  is  a  subject  which  physicians 
usually  avoid ;  yet  it  is  of  overtowering  importance,  and 
should,  therefore,  be  freed  from  the  ballast  of  misconcep- 
tions and  quackish  notions  with  which  it  is  encumbered. 
It  should  be  studied  and  worked  out  like  all  other  problems 
in  natural  history.  The  same  might  be  said  about  somatic 
radio-activity  (animal  magnetism)  which  is  a  physical  real- 
ity and  offers  an  almost  boundless  territory  for  research  and 
experiment,  even  in  a  therapeutic  direction.  By  solving 
these  problems  we  will  get  closer  to  the  true  inwardness  of 
life,  of  nature,  of  our  own  place  in  the  vast  domain  of  exist- 
ing things  and  might  lift  the  veil  that  hides  the  Whence? 
Where?  and  Whither?  from  the  eyes  of  mortal  man.  The 
acquisition  of  knowledge  for  the  improvement  of  our  fel- 
low-men, or  even  for  the  sake  of  possessing  knowledge,  is 
the  one  ideal  that  makes  life  worth  living. 


158  MODERN  PHYSIO-THERAPY. 


CHAPTER  VII. 
THE  THERAPY  OF  LIGHT. 

"Water  is  great;  air  is  greater;  but  the  greatest  of  all  is 
light." — PETTENKOFER. 

"Light  is  indeed  a  priceless  gift  of  heaven. 
It  is  the  life  of  every  living  thing." — SCHILLER. 

"Mehr  Licht!" — GOETHE. 

AMONG  the  many  brilliant  achievements  of  modern 
scientific  medicine  the  therapy  of  light  occupies  a  com- 
manding position.  Even  the  immortal  work  of  Roentgen 
has  not  been  able  to  obscure  the  brilliancy  of  the  labors  done 
by  Finsen  and  his  pupils.  The  practical  results  accom- 
plished by  the  scientific  application  of  rays  of  light  have 
gained  for  these  methods  a  high  and  undisputed  place  among 
the  therapeutic  resources  of  to-day.  In  view  of  the  fact  that 
we  have  not  as  yet  advanced  beyond  the  threshold  of  this 
era  of  great  achievements,  it  behooves  us  to  add  our  mite 
to  the  sum-total  of  knowledge  and  experience  and  thus  help 
in  the  elaboration  of  the  vast  possibilities  which  the  subject 
offers.  Among  the  various  physical  or  mechanical  thera- 
peutic agents  known  to  modern  medicine  light  is,  in  point 
of  clinical  usefulness  and  therapeutic  efficacy,  surely  en- 
titled to  a  foremost  place.  Together  with  water  and  air  it 
represents  a  disease-preventing  and  disease-curing  factor  of 
overtowering  importance.  It  is  one  of  the  elements  with- 
out which  life  is  impossible.  Upon  this  point  all  scientific 
men  are  agreed.  Not  all  physiologists,  however,  seem  to 
realize  that  the  hygienic  importance  of  light  is  not  greater 
than  its  curative  power.  This  is  a  categorical  statement 


THE  THERAPY  OF  LIGHT.  159 

which  I  hope  to  demonstrate  if  only  to  stimulate  thought 
along  the  lines  of  rational  therapeutic  methods. 

In  considering  light  as  a  health-preserving  and  health- 
restoring  factor,  it  behooves  us  to,  in  a  general  way,  try  to 
understand  its  enormous  importance  in  conjunction  with 
different  phases  of  physical  life,  and  more  especially  to  ap- 
preciate its  influence  upon  those  changes  in  the  animal 
economy  which  are  included  under  the  head  of  "Metabol- 
ism." If  the  absence  of  light  is  capable  of  causing  disease, 
it  is  not  unreasonable  to  assume  that  the  presence  of  light 
will  prevent  disease.  We  may  begin  our  reasoning  by  stat- 
ing that  the  human  body  requires  light  for  its  sustenance. 
The  most  vital  of  all  physiological  processes,  namely  respira- 
tion, both  cutaneous  and  pulmonary,  is  directly  affected  by 
the  presence  or  absence  of  light.  The  quantity  of  oxygen 
which  is  taken  up  by  the  tissues  is  directly  dependent  upon 
the  relative  amount  of  light  to  which  the  body  surface  is  ex- 
posed. During  the  day  the  human  body  takes  in  more  oxy- 
gen and  excretes  a  relatively  greater  amount  of  carbonic 
acid.  This  is  due  partly  to  the  increased  amount  of  oxygen 
in  the  air  during  the  day,  partly  to  the  greater  receptive  and 
assimilative  power  which  the  body  possesses  under  the  in- 
lluence  of  light.  When  the  sun,  the  great  source  of  light, 
approaches  the  horizon  and  leaves  the  world  to  darkness  and 
to  the  analyzing  physicist,  it  seems  as  though  all  nature  were 
lulled  to  sleep.  Its  voices  are  hushed,  and  man  and  beast 
are  slowly  rocked  to  rest  in  the  cradle  of  universal  silence. 
The  evidences  of  activity  gradually  disappear.  Darkness 
supervenes,  and  with  it  a  desire  to  rest  becomes  manifest 
throughout  the  living  creation.  The  human  organism,  which 
is  a  part  of  the  living  creation,  shares  in  this  general  de- 
pression of  vitality.  Its  machinery  works  under  lower  pres- 
sure. Physiological  respiration  becomes  more  superficial, 
assimilation  less  active  and  excretion  more  sluggish.  The 
more  finely  organized  the  structure,  the  more  characteristic 
the  change  which  comes  over  it  in  the  absence  of  light. 
Onlv  +h<*  lower  form  of  life,  the  fungi  and  other  forms  of 


160  MODERN  PHYSIO-THERAPY. 

micro-organisms,  thrive,  their  greatest  antagonist,  light, 
having  temporarily  withdrawn  from  the  field  of  contest.  In 
view  of  all  these  facts  we  can  readily  understand  that  condi- 
tions which  are  due  to  perverted  metabolism  or  produced  by 
the  action  of  bacterial  life,  are  necessarily  or  intimately  de- 
pendent upon  the  presence  or  absence  of  light. 

The  researches  concerning  the  biologic  importance  of 
light  in  conjunction  with  the  functions  of  the  human  organ- 
ism have  indeed  revealed  many  interesting  facts.  It  has 
been  shown  that  light  will  affect  the  contractility  of  proto- 
plasm. The  red  blood-corpuscles,  the  direction,  speed  and 
duration  of  the  movements  of  certain  infusoria  and  dia- 
tomes  are  directly  influenced  by  light.  The  muscular  ex- 
citation and  activity  of  frogs  has  been  shown  to  be  much 
more  energetic  under  the  influence  of  light  than  in  the  ab- 
sence of  light.  It  has  been  proven  that  the  quantity  of  col- 
oring matter  in  the  red  blood-corpuscles  increases  and  de- 
creases in  accordance  with  the  amount  of  light  to  which  the 
animal  body  is  exposed.  That  light  is  fatal  to  bacterial  life, 
had  been  suspected  by  many  observers  long  before  the  time 
of  Finsen.  As  far  back  as  1870,  Esmarch  exposed  his  sur- 
gical instruments  to  the  rays  of  the  sun  for  the  purpose  of 
disinfection.  Light,  in  factr  occupies  the  position  of  the  uni- 
versal disinfectant  because  without  it  the  purification  of 
river  water  would  be  inconceivable.  There  is  no  longer  any 
doubt  that  the  pathogenic  bacteria  are  affected  by  the  action 
of  light.  Geisler  exposed  a  culture  of  typhoid  bacilli  to  the 
light  of  a  thousand  candle  power  arc-light  and  after  three 
hours  of  illumination  the  growth  of  the  culture  had  been 
practically  suspended.  Aufrecht  inoculated  various  ani- 
mals with  the  bacilli  of  Milzbrand.  diphtheria  and  tubercu- 
losis. The  inoculated  animals  which  were  kept  in  the  dark 
died  within  two  or  three  days.  Those  exposed  to  the  light 
usually  resisted  the  effects  of  the  inoculation.  The  beneficial 
effect  of  light  as  a  germicidal  factor  and  an  oxypfenator  is 
seen  in  cases  of  tuberculosis  of  the  peritoneum  in  which  an 
exploratory  incision  is  frequently  followed  by  distinct  im- 
provement. 


THE  THERAPY  OF  LIGHT.  161 

In  order  to  understand  the  therapy  of  light  it  is 
necessary  to  know  something  about  the  physics  of  light. 
If  we  cause  the  white  light  of  the  sun  or  of  the 
electric  arc-light  to  fall  through  a  prism,  the  result 
is  a  splitting  up  of  the  light  into  its  component  rays. 
Technically  the  arrangement  of  the  component  rays  of 
white  light  is  known  as  the  solar  spectrum.  It  having  been 
shown  that  the  spectrum  of  the  arc-light  is  practically  iden- 
tical with  that  of  the  sun,  the  difference  in  the  light  being 
one  of  intensity  and  not  of  kind,  the  physical  and  therapeutic 
attributes  of  the  solar  and  arc-light  can  reasonably  be  sup- 
posed to  be  the  same.  Clinical  and  spectroscopic  observa- 
tions have  confirmed  the  correctness  of  the  supposition. 

The  seven  different  colors  or  rays  of  light  are  red, 
orange,  yellow,  green,  blue,  indigo  and  violet.  These  rays 
are  known  as  the  visible  rays  in  contradistinction  to  numer- 
ous forms  of  in-visible  light-energy  situated  beyond  either 
end  of  the  spectrum  (infra-red  and  ultra- violet  rays). 
Some  of  the  rays,  notably  those  emanating  from  the  red  and 
more  especially  from  the  infra-red  fields  of  the  spectrum, 
produce  heat  and  are,  therefore,  known  as  thermic  rays. 
Other  rays,  particularly  the  yellow  and  green,  are  light- 
producers  and  are  known  as  luminous  rays.  The  rays  of 
the  blue,  indigo,  violet  and  more  especially  the  (invisible) 
ultra-violet  fields  are  capable  of  producing  characteristic 
changes  in  the  chemical  composition  of  organic  and  inor- 
ganic matter  and  are  commonly  known  as  chemical  rays. 
They  are  also  called  actinic  rays.  The  most  powerful  chem- 
ical rays  emanate  from  the  ultra-violet  field  and  are  invisi- 
ble. Let  us  remember  once  for  all  that  the  term  "ultra- 
violet" refers  to  the  spectroscopic  location  of  these  invisible 
rays  and  not  to  any  particular  color.  The  view  held  by 
some  ill-informed  physicians  that  ultra-violet  means  in- 
tensely violet  or  a  deep  violet,  is  therefore,  manifestly  ab- 
surd. 

In  the  year  1893  Niels  R.  Finsen,  of  Copenhagen,  Den- 
mark, published  the  results  of  certain  biological  researches 


162  MODERN  PHYSIO-THERAPY. 

in  reference  to  the  action  of  the  different  rays  of  the  sun 
(or,  for  that  matter,  of  the  electric  arc-light),  more  espe- 
cially of  the  chemical  rays,  i.  e.  light  minus  the  thermic  and 
luminous  rays.  The  effects  of  the  chemical  rays  play  a 
most  important  part  in  the  life-process  of  the  whole  creation. 
They  are  the  motive  power  by  which  the  metabolism  of  the 
living  world  around  us  is  made  possible, — from  the  life 
process  within  the  organism  of  the  tiny  insect  to  the  re- 
generation of  the  vast  bodies  of  water  which  carry  the  ex- 
creta of  millions  of  people  and  yet  furnish  healthful  drink- 
ing-water after  the  sunlight  with  its  regenerating  chemical 
rays  has  caused  the  messengers  of  decay  and  death  to  be- 
come carriers  of  life  and  health.  The  chemical  rays  are 
the  most  easily  refracted  rays.  They  are  broken  by  the 
moisture  and  gases  in  the  atmosphere  and  by  the  surface  of 
the  earth.  The  heat-rays  are  the  least  refrangible  rays. 
Thus  it  is  that  chemical  rays  permeate  the  dark  of  night 
long  after  the  heat-  and  light-rays  of  the  sun  have  ceased  to 
act.  The  fact  that  owls  and  cats  see  at  night  is  attributed  to 
the  peculiar  construction  of  their  visual  apparatus,  which  is 
acted  upon  by  the  chemical  rays. 

Finsen  was  not  slow  in  applying  the  lessons  which  his 
studies  had  taught  him.  His  first  attempt  to  apply  light  to 
diseased  processes  and  tissues  gave  the  sanction  of  science 
to  the  empirical  therapy  of  light  which  had  been  in  vogue 
since  the  days  of  Hippocrates;  they  marked  the  birth  of 
modern  photo-therapy  as  an  exact  science  with  a  vast  sphere 
of  usefulness.  The  first  scientific  fact  which  Finsen  gave  to 
the  world  as  a  result  of  close  observation  and  study  at- 
tracted universal  attention  to  him  and  his  work.  It  per- 
tained to  the  scars  of  smallpox,  which  Finsen  showed  to  be 
due  to  the  disintegrating  effect  of  the  chemical  rays  of  light. 
He  reasoned  that  these  scars  could  be  prevented,  if  the  pa- 
tient could  be  protected  against  the  chemical  rays.  By  ex- 
periment he  proved  that  the  chemical  ravs  will  not  penetrate 
red  media,  and  proceeded  to  applv  this  fact  practicallv  by 
causing  the  windows  of  the  sick-room  to  be  painted  red,  by 


THE  THERAPY  OF  LIGHT. 


163 


causing  the  walls  of  the  room  to  be  covered  with  red  paper, 
in  fact  by  interposing  red  anywhere  and  everywhere  in 
order  to  intercept  the  chemical  rays.  Finsen  achieved  his 
first  triumph  when  the  results  abundantly  proved  the  truth 
of  his  statement.  The  principle  of  the  red-light  treatment 
of  smallpox  can  be  interestingly  illustrated  by  a  very  simple 
experiment.  Take  a  piece  of  sensitized  paper  and  place  on 
it  a  piece  of  red  glass.  Expose  the  whole  to  the  sun's  rays 


FINSEN'S  DEVICE  FOR  CONCENTRATING  AND  COOLING  THE 
RAYS  OF  THE  SUN. 

for  a  little  while  and  it  will  be  found  that  the  part  of  the 
paper  under  the  glass  has  remained  unchanged  while  the 
rest  of  the  paper  has  become  rapidly  discolored. 

The  marked  germicidal  action  of  the  chemical  rays 
prompted  Finsen  to  apply  them  to  infected  skin.  The  class- 
ical example  of  a  condition  of  this  kind  is  lupus  or  tuber- 
culosis of  the  skin.  Finsen  devised  an  apparatus  which 
would  be  adapted  to  this  purpose.  He  concentrated  these 
rays  by  eliminating  the  heat-  and  light-producing  rays  from 


164  MODERN  PHYSIO-THERAPY. 

the  mass  of  light  emanating  from  the  generating  source, 
which  was  either  the  sun  or  a  powerful  arc-light.  By  caus- 
ing the  light  to  fall  through  a  sheet  of  water,  all  the  heat- 
rays  were  practically  absorbed,  and  the  light  was  rendered 
cold.  By  adding  methylene-blue,  potassium  permanganate 
or  certain  other  coloring  agents  to  the  water,  Finsen  en- 
hanced the  effect  of  eliminating  the  red  or  heat-rays.  At 
the  same  time  he  found  that  many  of  the  light  rays  were 
lost.  His  idea  was  to  get  as  compact  a  concentration  of 
chemical  (ultra-violet)  rays  as  possible.  These  concen- 
trated rays  were  condensed  by  means  of  a  suitable  lens,  and 
were  directed  upon  or  against  the  affected  part  of  the  body. 
Finsen  found  by  spectroscopic  analysis  that  the  ordinary 
glass  lens  was  unavailable  because  glass  absorbs  the  chem- 
ical rays  either  entirely  or  to  a  large  extent.  He,  therefore, 
substituted  lenses  made  of  quartz  or  rock  crystal,  which  al- 
lows the  chemical  rays  to  pass.  He  found  by  experiment  that 
blood  absorbs  chemical  rays.  The  experiment  by  which  he 
established  this  fact  is  too  clever  and  interesting  to  be 
omitted.  Finsqn's  helpmate  in  his  great  work  was  his  wife, 
who  gladly  offered  herself  as  a  subject  for  experiment 
whenever  her  distinguished  husband,  after  experimenting 
on  his  own  skin,  desired  further  experimental  proof  for 
any  of  his  investigations.  Finsen  placed  a  piece  of  sensitive 
r  holographic  printing  paper  in  direct  contact  with  the  pos- 
terior surface  of  his  wife's  ear.  He  directed  a  beam  of 
chemical  light  to  fall  upon  the  anterior  surface  of  the  ear. 
No  matter  how  long  the  exposure  was  continued,  there  was 
no  effect  on  the  paper.  After  placing  the  ear  between  two 
thin  pieces  of  quartz,  rendering  it  anemic  by  pressure,  he 
icpeated  the  experiment.  The  paper  turned  black  within  a 
few  moments,  showing  that  the  blood  had  previously  pre- 
vented the  passage  of  the  rays.  This  fact  suggested  to  him 
the  necessity  of  covering  the  part  to  be  treated  with  a  piece 
of  rock-crystal  in  order  to  render  the  part  bloodless.  Fin- 
sen  evolved  step  by  step  the  technical  details  of  the  method 
which  was  destined  to  become  so  powerful  a  factor  in  the 


THE  THERAPY  OF  LIGHT.  165 

treatment  of  a  variety  of  conditions.  The  essential  features 
of  a  Finsen  apparatus,  therefore,  are :  a  source  of  chemical 
light,  a  large  condensing  lens  to  concentrate  the  rays  ema- 
nating from  the  source,  a  water-receiver  through  which  the 
light  passes  and  in  which  it  loses  all  its  heat-rays,  a  small 
condenser  to  collect  the  chemical  rays  which  have  emerged 
from  the  water,  and  a  pressure-crystal  to  render  the  skin 
anemic.  These  essential  features  are,  to  a  larger  or  smaller 
extent,  embraced  in  all  the  devices  which  have  been  con- 
structed after  the  type  suggested  by  Finsen  himself. 

Finsen's  original  type  was  open  to  many  objections.  In 
using  the  electric  arc-light,  Finsen  constructed  light-genera- 
tors of  tremendous  power.  He  speaks  of  80  ampere  arc- 
lights.  It  is  needless  to  refer  to  the  clumsiness  and  dangers 
of  such  an  apparatus.  An  equally  justifiable  objection  is 
the  fact  that  the  peculiar  construction  of  the  original  Fin- 
sen  lamp  involved  great  loss  of  light.  Over  60  per  cent  of 
the  light  produced  by  the  apparatus  were  lost.  Finsen  sus- 
pended the  50  or  80  ampere  lamp  from  the  ceiling,  placing 
four  or  six  telescopic  tubes  at  an  angle  below  the  lamp,  one 
patient  being  treated  under  each  tube.  It  stands  to  reason 
that  more  than  half  the  light  of  the  lamp  is  lost  in  this  way 
because  only  a  comparatively  small  portion  of  the  light  is 
received  by  the  tubes.  A  perusal  of  Finsen's  book  ("Ueber 
die  Wirkung  der  concentrirten  chemischen  Lichstrahlen") 
will  show  the  principles  underlying,  as  well  as  the  imper- 
fections involved  in  Finsen's  original  lamp.  The  heat-pro- 
duction of  so  high  an  arc  is  also  a  factor  of  some  conse- 
quence, not  to  speak  of  the  expense  of  constructing  and 
maintaining  the  apparatus. 

To  make  the  Finsen  idea  practically  available,  many  at- 
tempts have  been  made  to  modify,  or  rather  to  simplify, 
the  original  device.  The  best  known  modification  is  prob- 
ably the  portable  Finsen  lamp  devised  by  Sequeira  and  gen- 
erally known  as  the  London  Hospital  Lamp.  It  is  simple 
in  construction,  easy  to  handle,  neat  in  appearance  and 
possesses  considerable  therapeutic  power.  It  furnishes  a 


166 


MODERN  PHYSIO-THERAPY. 


cold  light,  the  cold  water  constantly  circulating  in  front  of 
the  powerful  arc-light.  Another  very  useful  modification  of 
Finsen's  device  is  the  hand-lamp  invented  by  Kjeldsen,  of 
Copenhagen,  and  known  as  the  Dermo  Lamp.  Katten- 
bracker,  of  Spandau,  used  one  of  Kjeldsen's  lamps  for  the 
purpose  of  studying  the  effect  of  light  on  germ-life.  The 
lamp  is  held  by  the  operator.  It  is  supplied  with  hollow 
iron-electrodes,  through  which  cold  water  constantly  flows, 
rendering  the  light  cold.  The  cone  of  light  is  small,  but 


LONDON  HOSPITAL  LAMP. 

qualitatively  powerful.  Kattenbracker  used  the  light  from 
this  lamp  at  a  distance  of  10  centimeters  (arc  5  amp.  40  v. 
direct  current).  He  used  15  p.  c.  nutritive  gelatine  as  a  cul- 
ture-medium for  gonococci  and  tubercle  bacilli,  2  p.  c. 
glycerine-agar  covered  with  sterilized  blood-serum  for 
typhoid  and  other  germs.  The  germs  were  grown  in  sur- 
face-cultures on  plates  at  a  temperature  of  22  C.  The  con- 
trol-cultures were  kept  at  35  C.  to  allow  for  the  slight  rise 
in  the  temperature  of  the  light  from  the  lamp.  Inoculation 
from  the  rayed  cultures  on  glycerine-agar  was  made  after 
forty-eight  hours  and  the  new  culture  kept  at  a  temperature 


THE  THERAPY  OF  LIGHT. 


167 


A  "DERMO"  EQUIPMENT. 

v  and  w  are  the  rubber  tubes  for  carrying  (supply  and  waste)  water  to  and  from 
the  lamp.  The  electrodes  are  iron  and  hollowed  out  to  allow  the  water  to  circulate. 
h  is  the  handle  of  the  current-controller  («).  MS  the  current-switch,  k  is  the  fuse-box. 
m  is  the  ammeter.  /  (l,  2,  3)  is  the  current- supply.  The  wires  from  /2  represent  a  loop 
in  the  circuit  to  prevent  the  formation  of  an  arc  in  the  lamp  unless  the  water  is  flowing. 
The  pressure  of  the  water  distends  the  rubber  tube  and  by  an  ingenious  arrangement 
completes  the  circuit. 


168  MODERN  PHYSIO-THERAPY. 

of  35  C.  for  forty-eight  hours.  The  relative  viability  of  the 
new  culture  was  taken  as  a  criterion  for  the  relative  germi- 
cidal  power  of  the  light. 

Typhoid  Bacillus.  After  an  exposure  to  Kjeldsen's  light 
lasting  one  second  there  was  no  effect.  After  three  seconds 
growth  markedly  impaired.  After  thirty  seconds  vitality 
almost  suspended.  After  sixty  seconds  culture  was  dead. 

Comma  Bacillus.  No  effect  after  five  seconds.  Impair- 
ment after  thirty  seconds.  Death  after  two  minutes. 

Tubercle  Bacillus.  Slight  impairment  after  five  seconds. 
Marked  impairment  after  sixty  seconds.  Death  after  two 
and  one-half  minutes. 

Micrococcus  Gonorrhoicns.  Slight  impairment  after 
five  seconds.  Marked  impairment  after  thirty  seconds. 
Death  after  two  minutes. 

Bacterium  Coli  Commune.  Impairment  after  thirty  sec- 
onds. Death  after  two  minutes. 

Streptococcus  Pyogenes.  Impairment  after  thirty  sec- 
onds: Death  after  three  minutes. 

Anthrax.  Impairment  after  five  seconds.  Death  after 
thirty  seconds. 

In  the  types  of  Finsen-lamps  recently  employed  the 
luminous  rays  are  not  eliminated.  Finsen's  subsequent  ex- 
periments have  shown  that  exclusion  of  the  light  rays  is  not 
essential.  I  am  even  inclined  to  think  that  the  presence  of 
the  light  rays  is  not  only  not  objectionable,  but  rather  de- 
sirable. Light  has  a  regenerating  and  germ-killing  effect 
and  likewise  a  strong  affinity  for  oxygen.  Its  presence  would, 
therefore,  rather  tend  to  enhance  the  action  of  the  chem- 
ical rays.  The  principal  thing  is  to  get  rid  of  the  heat  rays. 

What  is  the  physiological  action  of  the  chemical  light? 
If  a  beam  of  concentrated  chemical  light  is  allowed  to  fall 
upon  healthy  skin,  the  eventual  result  will  be  an  erythema 
followed  by  much  local  irritation,  dermatitis,  molecular 
death  and  desquamation.  The  tanning  of  the  skin  in  the 
summer  is  the  result  of  the  deposition  of  pigment  in  the 
skin.  Pigment  is  nature's  safeguard  against  the  destructive 


THE  THERAPY  OF  LIGHT.  169 

» 

action  of  the  chemical  rays,  the  latter  being  absorbed  by  it. 
Chemical  light  seems  to  affect  the  procreative  function  of 
plants  and  animals  as  far  as  the  sex-production  is  concerned. 
Chemical  light  favors  the  production  of  males.  The  germ- 
killing  power  of  chemical  light  has  been  proven  beyond  a 
doubt.  It  has  a  strong  affinity  for  oxygen.  It  produces  a 
disintegrating  effect  upon  living  tissues.  The  greater  the 
resisting  power  of  the  tissues,  the  less  intense  will  be  the 
action  of  the  chemical  rays.  Since  morbid  tissues  are  less 
viable  than  the  normal,  the  destructive  effect  of  the  chem- 
ical rays  upon  the  cutaneous  tissues  wherein  tubercle-bacilli 
or  other  germs  have  found  lodgment,  can  be  readily  under- 
stood. The  treatment  of  lupus  is  the  classical  example  of 
the  physiological  action  of  Finsen's  rays.  Their  germ-kill- 
ing power  strikes  at  the  very  essence  of  the  affliction.  They 
stimulate  healthy  action  by  attracting  oxygen  to  the  part. 
The  morbid  tissues  of  the  afflicted  portion  are  disintegrated 
by  the  rays.  In  this  way  a  healthy  reaction  is  set  up,  which 
tends  towards  restoration  of  the  normal  condition.  The 
consistent  and  persistent  use  of  the  Finsen  lamp  is  indi- 
cated in  all  parasitic  skin-diseases.  Lupus,  sycosis,  tinea, 
certain  forms  of  chronic  eczema,  psoriasis,  disease  of  the 
hair  follicles,  furuncle,  carbuncle,  alopecia  areata,  etc.,  fur- 
nish a  rich  field  for  successful  clinical  work.  What  degree 
of  clinical  usefulness  may  be  attributed  to  these  rays  in  the 
treatment  of  internal  diseases,  we  are  not  as  yet  prepared  to 
say.  That  the  body  is  practically  translucent  or  can  be 
made  so,  can  not  be  questioned.  It  is  needless  to  point  out 
the  enormous  importance  of  this  fact  in  connection  with 
the  possibilities  which  chemical  light  offers  in  the  treat- 
ment of  tuberculosis  of  internal  parts,  especially  in  cases  of 
incipient  tuberculosis  of  the  apices  of  the  lungs. 

It  may  not  be  amiss  to  call  attention  to  two  interesting 
facts  which  seem  to  have  been  established  through  the 
biological  researches  of  Finsen : 

i.  Pigment  in  the  skin  absorbs  chemical  rays.  The  more 
pigment  in  the  skin,  the  smaller  the  amount  of  chemical 


170  .MOD::RX 


light  which  penetrates  into  the  interior  of  the  body,  the  less 
disinfection  of  the  interior.  Since  anerobic  germs  thrive  in 
the  absence  of  light,  we  may  reasonably  suppose  that  the 
tendency  toward  tuberculosis  is  in  direct  proportion  to  the 
amount  of  pigment  in  the  skin.  The  negro  is  notoriously  a 
ready  victim  of  the  tubercle  bacillus. 

2.  The  plasmodium  malaria?  becomes  inactive  in  the  ab- 
sence of  light.  This  has  been  shown  experimentally.  If 
light  is  excluded  from  the  skin  of  a  malarial  patient,  the 
malarial  attack  is  modified  or  even  aborted..  This  has  been 
demonstrated  by  the  darkness-treatment  of  malaria  adopted 
by  American  army  surgeons  in  Puerto  Rico.  The  treatment 
consists  in  confining  the  patient  in  a  dark  room  for  many 
days.  Corroborative  evidence  is  furnished  by  the  fact  that 
malarial  attacks  hardly  ever  occur  at  night,  and  by  the  addi- 
tional fact  that  the  negro  is  practically  free  from  malaria. 
(These  conclusions  are  not  altogether  above  criticism.  See 
MALARIA.) 

Let  us  not  forget  that  the  mechanical  devices  which  — 
thanks  to  the  genius  of  Finsen  —  have  assumed  so  important 
a  place  in  our  therapeutic  armamentarium,  are  at  best  but 
poor  substitutes  for  Nature's  own  light-producer,  the  sun. 
Sunlight  —  that  greatest  and  cheapest  of  all  therapeutic 
agents  —  how  little  the  average  physician  appreciates  its 
curative  power  !  The  healthy  human  body  needs  it,  the  sick 
human  body  imperatively  demands  it.  It  is  the  beginning  of 
hygiene  in  health  and  disease.  It  is  a  necessary  condition  of 
life  under  any  and  all  circumstances.  It  is  to  the  skin  what 
oxygen  is  to  the  lungs.  Life  is  impossible  without  either. 
In  cases  of  tuberculosis  pulmonum  treatment  is  not  complete 
unless  sunlight  is  included.  The  skin  performs  a  compen- 
satory function  for  the  disabled  and  impaired  pulmonic 
apparatus.  In  all  chronic  diseases  the  importance  of  sun- 
light, especially  the  light  of  the  morning-sun  which  is  rich 
in  chemical  rays  with  a  comparative  scarcity  of  thermic  rays, 
can  not  possibly  be  overestimated.  In  the  times  of  Pericles 
the  daily  sun-bath  was  as  much  a  necessary  health-measure 


THE  THERAPY  OF  LIGHT.  171 

as  the  ablution  of  the  hands.  This  advanced  and  enlightened 
age  of  ours  would  do  well  to  turn  back  to  the  days  of  Hip- 
pocrates and  learn  the  eternal  and  immutable  principles 
which  in  our  busy  evolution  of  a  thousand  unimportant  de- 
tails, we  have  no  time  to  remember.  The  helio-therapy  and 
solarium  of  the  old  clinicians  served  an  admirable  purpose 
and  deserve  to  be  revived  wherever  opportunity  or  space 
will  permit. 

The  clinical  uses  of  the  thermic  rays  are  suggested  by 
the  physiological  action  of  heat.  Wherever  and  whenever 
heat  is  indicated,  the  thermic  rays  will  answer  the  purpose. 
The  ordinary  incandescent  globe  is  a  splendid  source  of  dry 
heat  and  has  recently  risen  to  a  high  plane  of  clinical  im- 
portance through  the  labors  of  Dr.  A.  W.  Minin,  of  St. 
Petersburg,  whose  heat-reflector  (blue  incandescent  globe 
of  suitable  candle-power  in  a  parabolic  reflector)  is  a  sim- 
ple and,  withal,  an  extremely  useful  device.  It  is  neat,  sim- 
ple, clean,  easily  manipulated  and  meets  an  almost  endless 
number  of  clinical  indications.  It  is  more  than  the  old-fash- 
ioned flaxseed  poultice  without  the  bulk,  filth,  labor,  stench 
and  other  disagreeable  features  of  the  latter.  The  color  of 
the  globe  is  what  gives  to  this  light  its  pain-relieving  action. 
Minin  insists  upon  spectroscopic  examination  of  the  blue 
globes  used  to  make  sure  of  the  presence  of  a  large  per- 
centage of  blue  light.  The  following  points  indicate  in  a 
general  way  the  sphere  of  clinical  usefulness  which  might 
reasonably  be  attributed  to  Minin's  device : 

Minin  showed  that  an  incandescent  light  placed  in  a 
parabolic  reflector  could  be  employed  to  furnish  dry  heat, 
the  calorific  radiations  giving  to  this  form  of  application  a 
remarkable  penetrating  power  not  possessed  by  any  other 
means  of  producing  hot  air.  In  addition  to  this  Minin 
availed  himself  of  the  peculiar  effects  which  blue  light  is 
capable  of  producing  on  the  sensory  nerves.  Blue,  indigo, 
and  violet  are  the  visible  chemical  rays.  They  are  not  equal 
to  the  invisible  actinic  (ultra-violet)  rays  in  germicidal 
power  or  in  affinity  for  oxygen.  They  are  sedative,  while 


172  MODERN  PHYSIO-THERAPY. 

the  actinic  rays  beyond  the  violet  field  are  distinctly  stimu- 
lating and  even  irritating.  No  one  has  ever  heen  able  to 
account  for  this  difference  in  a  strictly  scientific  way.  The 
Minin  light  is  poor  in  ultra-violet  radiations  and  rich  in 
visible  chemical  rays.  The  luminous  rays  are  comparatively 
scant,  while  the  calorific  rays  abound.  Thus  it  is  plain  that 
the  Minin  idea  has  nothing  in  common  with  the  Finsen 
light.  The  object  of  the  Minin  light  is  to  radiate  deeply 
penetrating  dry  heat  and  to  produce  visible  chemical  rays. 
Therein  lies  the  therapeutic  and  clinical  value  of  Minin's 
device. 

The  cutaneous  hyperemia  which  follows  an  application 
of  the  thermic  rays  produced  by  Minin's  device,  stimulates 
the  circulation  of  the  areas  treated,  unloads  the  veins,  stimu- 
lates the  functions  of  the  lymphatics,  depletes  the  deeper 
structures  and  accelerates  and  intensifies  local  metabolism. 
In  this  way  toxic  material  and  inflammatory  products  are 
excreted  or  absorbed,  the  nutrition  of  the  part  is  regen- 
erated and  a  powerful  impetus  given  in  the  direction  of  the 
restoration  of  normal  conditions.  The  peculiar  change  in 
the  appearance  of  an  ulcer  or  an  abraded  surface  which 
has  been  exposed  to  thermic  rays  is  due  to  the  coagulation 
of  the  albumen  which  gives  the  surface  an  appearance  as 
though  a  delicate  skin  had  formed  over  it.  The  penetrating 
character  of  Minin's  heat  rays  makes  them  available  when 
other  forms  of  dry  heat,  which  explode  on  the  skin  or  in 
the  subcutaneous  tissues,  would  inflict  unbearable  torture 
and  eventually  burn  and  destroy  the  tissues.  Minin's  device 
carries  the  beneficent  effects  of  dry  heat  into  the  deep  tis- 
sues. The  effects  on  the  local  circulatory,  metabolic  and 
absorptive  activities  are  most  profound.  In  cases  of  deep 
muscular  rheumatism  (for  instance,  lumbago)  the  Minin 
light  is,  for  the  reasons  given,  one  of  the  very  best  thera- 
peutic agents. 

The  blue  color  of  the  globe  gives  to  the  light  its  wonder- 
ful sedative  power.  The  Royal  Mausoleum  at  Charlotten- 
burg,  in  Germany,  has  a  reputation  of  being  a  veritable 


THE  THERAPY  OF  LIGHT.  173 

shrine  where  persons  with  shattered  nerves  can  find  peace 
and  comfort.  The  story  goes  that  the  spirit  of  the  sainted 
Queen  Louise,  the  idol  of  the  German  people,  hovers  about 
this  place  and  brings  peace  and  happiness  to  those  who  seek 
refuge  within  the  hallowed  walls  where  the  mortal  frame  of 
that  angel  of  peace  has  found  its  last  resting  place.  Physi- 
cians— for  science  is  brutally  truthful — attribute  the  seda- 
tive effects  to  the  mellow  blue  light  with  which  the  magnifi- 
cent stained  windows  flood  the  interior  of  that  historical 
place.  Finsen  explains  the  quiet  and  peace  of  the  evening 
hours  by  the  deep  blue  light  emitted  by  the  canopy  of 
heaven.  Many  experimenters  in  hypnotism  use  blue  light  to 
enshroud  the  organisms  of  their  subjects  with  the  tranquility 
which  facilitates  concentration  and  suggestive  control.  I 
have  demonstrated  the  sedative  effects  of  blue  light  by  plac- 
ing a  Minin  reflector  ten  feet  in  front  of  a  person  who  is 
comfortable  seated,  and  is  told  to  rivet  his  eyes  on  the  blue 
light  in  front  of  him.  The  average  person  falls  asleep  within 
five  minutes. 

In  the  cutaneous  tissues  the  sedative  effect  of  blue  light 
shows  itself  by  a  complete  suspension  of  sensation.  This 
fact  makes  blue  light  a  local  anesthetic  with  a  great  range  of 
usefulness,  especially  in  minor  surgery  and  in  dentistry.  In 
emergency  surgery  blue  light  not  infrequently  takes  the 
place  of  the  hypodermic  syringe. 

A  few  clinical  examples  will  serve  to  illustrate  the  use- 
fulness of  the  Minin  light. 

Discomfort  and  pain  in  the  region  of  the  stomach  or 
radiating  from  the  epigastrium,  nausea  or  an  uncomfortable 
sense  of  fulness  in  the  stomach  due  to  the  presence  of  gas 
or  presenting  itself  as  a  local  expression  of  a  general  neuras- 
thenic state,  or  due  to  a  neurosis  of  the  stomach,  can  be  eas- 
ily and  quickly  relieved  by  an  application  of  blue  light,  the 
patient  resting  comfortably  on  his  back  and  exposing  his 
epigastrium  to  the  radiations  from  a  Minin  reflector,  which 
is  placed  over  his  stomach.  Probably  in  no  other  variety  of 
clinical  cases  is  the  sedative  action  of  this  light  so  charac- 


174  MODERN  PHYSIO-THERAPY. 

teristic  as  in  the  conditions  named.  Relief  follows  immedi- 
ately, and  is  accompanied  by  a  sense  of  rest  fulness  of  the 
whole  system,  the  patient  not  infrequently  lapsing  into  a 
quiet  sleep. 

In  the  case  of  a  physician  who  was  badly  shaken  up  in  a 
railroad  accident  and  suffered  from  severe  pain  in  the 
muscles  of  the  chest  and  soreness  and  anxiety  around  the 
heart  I  suggested  the  use  of  the  Minin  light  on  the  exposed 
anterior  surface  of  the  chest.  Relief  was  prompt  and  com- 
plete. In  a  case  of  severe  contusion  of  the  lumbar  region, 
due  to  a  railroad  accident,  the  Minin  light  likewise  was  of 
great  service.  Motion  of  the  lower  extremities  was  painful 
and  difficult,  owing  to  the  injury  inflicted  on  the  soft  tissues 
surrounding  the  lumbar  spine.  I  used  the  Minin  light  on 
the  man's  back  every  other  day  for  a  month.  The  cure  was 
complete.  It  is  but  fair  to  state  that  each  illumination  was 
preceded  by  vigorous  vibration  of  the  lumbar  region. 

I  attended  another  physician  who  suffered  from  intense 
pain  around  the  rectum,  indicating  an  acute  inflammatory 
condition  in  the  circumrectal  cellular  tissue,  with  a  proba- 
bility of  abscess  formation.  The  pain  was  most  intense  and 
had  completely  prostrated  the  patient.  He  remained  under 
treatment  three  days.  Each  day  he  exposed  his  buttocks  and 
anus  to  the  light  from  a  Minin  lamp  for  one  hour.  The  pain 
was  relieved  by  the  first  treatment.  After  three  treatments 
every  vestige  of  the  inflammatory  condition  had  disap- 
peared. This  case  illustrated  the  remarkable  absorptive 
power  of  the  Minin  light. 

A  patient  presented  himself  with  a  distinct  bulging  on 
the  anterior  chest  wall  in  the  center  and  slightly  to  the  left 
of  the  sternum.  His  physician  had  told  him  that  the  swell- 
ing was  in  all  probability  due  to  an  aortic  aneurism.  There 
was  considerable  precordial  distress,  frequenly  aggravated 
by  shooting  pains.  Reserving  a  diagnosis  until  some  future 
time,  I  began  to  make  applications  of  blue  light,  and  suc- 
ceeded in  giving  the  man  a  good  deal  of  relief.  The  nature 
of  the  trouble  was  not  clear  to  me,  although  I  could  not 


THE  THERAPY  OF  LIGHT.  175 

make  up  my  mind  to  accept  the  provisional  diagnosis  made 
by  the  other  medical  attendant.  The  man  returned  day 
after  day  on  account  of  the  great  relief  which  the  blue  light 
gave  him.  After  a  dozen  applications  of  blue  light  the 
symptoms  of  a  developing  muscular  abscess  were  too  plain 
to  be  mistaken.  A  large  abscess  was  eventually  opened. 
Recovery  was  rapid  and  complete. 

In  the  treatment  of  chronic  ulcers,  chancres,  etc.,  much 
good  may  be  expected  from  the  use  of  the  Minin  light.  I 
have  seen  an  immense  varicose  ulcer  of  twenty  years'  stand- 
ing heal  up  under  blue  light  treatment.  In  cases  of  bubo 
the  Minin  light  is  of  great  service  to  abort  the  inflammatory 
process  or  to  accelerate  abscess  formation.  I  remember  a 
case  of  Hunterian  chancre  of  the  lower  lip,  with  consider- 
able local  disturbance,  glandular  involvement,  etc.  A  local 
skin  specialist  had  treated  the  patient  without  much  benefit. 
The  sore  seemed  to  be  of  the  -phagedenic  variety  and  had 
recently  become  very  painful.  The  seat  of  the  trouble  was 
exposed  to  the  light  from  a  small  Minin  lamp,  the  rest  of 
the  face  being  covered  with  towels.  The  patient  was  treated 
daily  for  thirty  minutes.  After  the  first  treatment  the  pa- 
tient had  no  more  pain ;  after  the  third  treament  the  sore 
showed  signs  of  a  favorable  reaction ;  after  the  eleventh 
treatment  the  patient  was  locally  well. 

There  are  hardly  any  limitations  to  the  therapeutic  uses 
of  the  Minin  light.  By  restoring  the  physiological  tone  of 
the  affected  area,  by  stimulating  and  correcting  metabolism, 
by  relieving  pressure  and  promoting  absorption  the  Minin 
light  is  useful  in  all  conditions  characterized  by  lowered 
vitality,  by  local  auto-intoxication,  passive  congestion,  etc. 
As  a  local  pain-reliever  it  stands  without  a  peer.  All  the 
various,  much  advertised  incandescent  lamps  of  high  power, 
placed  in  a  reflector  or  hood,  are  but  imitations  of  the  simple 
but  withal  powerful  device  originated  by  Minin. 


176  MODERN  PHYSIO-THERAPY. 

THE  ELECTRIC-LIGHT   I>ATH. 

After  all  that  has  been  stated  concerning  the  uses  of 
various  forms  of  light  we  are  prepared  to  understand  and 
appreciate  the  importance  and  usefulness  of  a  mechanical 
device  which  enables  use  to  make  practical  use  of  all  tlie 
various  physical  agencies  which  are  included  in  light.  The 
light  of  the  electric  arc  has  approximately  the  same  spectro- 
scopic  composition  as  sunlight.  The  light  of  the  incandes- 
cent globe  is  rich  in  thermic  rays.  Thus  we  are  prepared 
to  look  upon  the  electric-light  cabinet  as  a  valuable  addition 
to  our  therapeutic  armamentarium,  combining  as  it  does, 
the  power  of  the  various  rays  in  the  destruction  of  disease- 
germs,  in  the  re-establishment  and  stimulation  of  physiologi- 
cal metabolism  and  in  the  performance  of  the  many  im- 
portant functions  of  light  in  and  on  the  animal  economy. 

As  a  producer  of  copious  diaphoresis1  the  electric-light 
cabinet  rivals  the  dry-heat  cylinder.  Winternitz  states  that 
since  the  introduction  of  the  light-cabinet  he  has  practically 
abandoned  the  hot-air  cylinder.  The  light-bath  produces 
sweating  without  the  intense  heat  of  the  hot-air  apparatus. 
The  light-bath  is,  therefore,  indicated  in  all  cases  to  which 
the  dry-heat  apparatus  is  adapted.  Whenever  cutaneous 
excretion  is  to  be  stimulated,  the  dry-heat  cylinder,  and, 
therefore,  the  electric-light  cabinet  will  do  the  work.  Either 
will  alter,  stimulate  and  rectify  metabolism  promptly.  Either 
will  augment  absorption,  stimulate  the  appetite,  and  help 
the  organism  to  rid  itself  of  all  kinds  of  deleterious  gases, 
vapors  and  fluids.  The  following  statistical  list  of  diseases, 
with  the  percentage  of  cured  cases  added,  is  taken  from  the 
reports  of  one  of  the  numerous  German  photo-therapeutic 
institutions,  and  shows  the  clinical  importance  of  the  light- 
bath  more  eloquently  than  any  physiological  and  therapeutic 
argument  could  possibly  demonstrate  it.  The  cases  were  all 
treated  in  the  electric-light  bath. 

JIn  the  second  part  of  this  book  frequent  reference  is  made  i<> 
the  electric-light  bath.  This  invariably  refers  to  the  incandescent- 
light  bath  unless  the  arc-light  bath  is  spoken  of  as  such. 


THE  THERAPY  OF  LIGHT. 


177 


NAME  OF  DISEASE 

No.  of  Cases... 

Cured  

Much  Im- 
proved   

1 

K 

i 
r 

Rheumatism  

TT6 

8r 

V) 

Gout            

86 

e-J 

11 

"     Deformative  

3 

Neurasthenia  and  Hysteria  (nervous  disorders)  

87 

4S 

*I 

6 

61 

6 

16 

Obesity  

fr> 

TO 

12 

Asthma  

49 

4.O 

Gonorrhea  and  consequent  disorders  

•18 

20 

TK 

Heart  disease  

•?6 

g 

Fatty  Degeneration  of  the  Heart  

W 

20 

I"7 

Sciatica  '  

^2 

->8 

I 

Bronchial  Catarrh  and  Emphysema  

-8 

IO 

18 

Neuralg  ia  

24 

6 

17 

I 

Ulcus  Cruris  Varicosum  

23 

IO 

7 

6 

Stomach  and  Intestinal  Catarrh  

2O 

E 

JC 

Mild  Affections  of  the  Liver  

2O 

IO 

7 

Affections  of  the  Knee-joint  

15 

IO 

• 

Nephritis  

15 

It: 

Lumbago  

14 

Catarrh  of  the  Ear  and  Deafness  

J4 

I 

g 

Nasal  Catarrh   and  Affection  of  the  Larynx  

17 

c 

g 

Anemia   

12 

12 

Diabetes    

IO 

IO 

Headache           .               

( 

• 

Chronic  Constipation           

4. 

I 

•2 

Professional  Illnesses  

3 

2 

I 

Erysipelas       

•I 

•z 

Influenza                     

7 

« 

2 

2 

Ulcus    Molle  

I 

I 

Skin  Diseases  (Herpes,  etc  )  

63 

24 

7-1 

6 

Tabes  

40 

7 

33 

The  following  table  shows  the  results  of  light-treatment  in  an- 
other one  of  the  German  institutions  : 


NAME  OF  DISEASE 

No.  of  Cases... 

Cured  

g 

•o  s 

i* 

t  _ 

°-=r 

No  Result  

Neurasthenia  

23 

4 

9 

IO 

Myalgia  

14 

14 

Psoriasis  Luetica  

i 

I 

Psoriasis               

3 

I 

i 

I 

7 

I 

2 

Chronic  Rheumatic  Arthritis  

2O 

7 

IO 

•I 

Chronic  Muscular  Rheumatism  

is 

IO 

Gout                                   

2O 

9 

9 

2 

Neuralgia  

q 

5 

2 

2 

Abscess                                              

4 

i 

2 

T 

Influenza      

i 

i 

Furuncle                                               

2 

2 

I 

I 

Pru  ri  go                                                                         .  .       

I 

I 

Plethora  

2 

I 

I 

Meningitis  Spinalis 

I 

Lupus  

I 

I 

178 


MODERN  PHYSIO-THERAPY. 


It  behooves  me  to  emphasize  the  importance  of  the  light- 
bath  in  the  treatment  of  wounds,  injuries,  and  also  as  an  ad- 
junct in  the  practice  of  operative  surgery.  Wounds  under 
the  influence  of  light  heal  promptly  and  without  much  local 
disturbance.  In  selecting  an  electric-light  cabinet  the 
physiological  effect  to  be  produced  should  not  be  lost  sight 
of.  In  the  arc-light  cabinet  the  chemical  rays  abound.  In 
the  incandescent-light  cabinet  the  heat-rays  predominate. 
In  addition  to  this  it  is  important  to  remember  that  dis- 
tinctly local  conditions  are  best  treated  in  a  cabinet  cor- 
responding in  size  to  the  part  to  be  treated.  Electric-light 
cabinets  and  cylinders  are  made  in  all  shapes  and  sizes. 


ECLECTRIC  LIGHT  BATH  FOR  SPECIAL  PARTS  OF  THE  BODY. 

The  discussion  of  this  interesting  subject  would  not  be 
complete  without  at  least  a  cursory  mention  of  the  effects  of 
different  colors  of  light  in  the  cabinet  (chromo-therapy). 
Abstracting  from  the  many  illusory  statements  which  have 
been  made  on  this  subject  by  physicists,  poets  and  others 
from  the  time  of  Goethe  up  to  the  present,  there  can  be  no 
doubt  that  the  human  organism,  even  aside  from  the  re- 
sponsive function  of  the  visual  apparatus,  is  affected  by 
different  colors  in  characteristic  ways.  Red  is  the  nerve- 
stimulant  par  excellence.  It  acts  upon  the  sympathetic 
nervous  system  and  through  this  upon  all  the  vegetable  and 
more  especially  the  animal  functions  of  the  economy.  The 


THE  THERAPY  OF  LIGHT. 


179 


INCANDESCENT  AND  ARC  LIGHT  BATH  CABINET. 


180 


MODERN  PHYSIO-THERAPY. 


THE  THERAPY  OF  LIGHT. 


181 


sexual  organs  are  easily  affected  by  red  color-effects.  The 
red  lights,  gowns  and  furnishings  of  the  shrines  of  Venus 
Vulgivaga  are  not  without  their  purpose.  Red  has  ever 
been  known  as  the  color  of  passion  and  love.  Green  is  a 
mild  sedative.  It  quiets  the  mind  and  eases  the  body.  A 
sense  of  buoyant  tranquillity  and  hopeful  expectancy  comes 
over  the  organism.  Blue  is  still  more  distinctly  sedative.  It 


BIDET  FOR  APPLICATION  OF  LIGHT  TO  THE  EXTERNAL 
FEMALE  GENITALIA. 

is  said  to  rectify  metabolism,  to  cleanse  the  organism  and  to 
rejuvenate  the  weak  and  ill.  White  combines  the  effects  of 
all  the  colors. 

So  much  for  light  and  its  therapy.  "Let  there  be  light !" 
The  Creator  wisely  indicated  a  great  photo-therapeutic  truth 
in  these  words.  First  he  wanted  light,  then  he  created  life. 
We  must  have  light  before  we  can  have  life  and  health. 
Let  us  have  light,  for — by  the  Shades  of  Hippocrates ! — 
we  can  not  get  too  much  light  in  medicine. 


182 


MODERN  PHYSIO-THERAPY. 


DIAGRAM  OF  AN  INDUCTION  COIL. 

Current  starts  at  battery-post  A,  splits  up  at  D,  supplying  the 
primary  post  C,  the  other  branch  connecting  with  the  primary 
coil  (D  and  B).  From  the  primary  coil  the  curent  goes  to  the 
vibrator  and  hammer.  The  circuit  is  completed  through  the 
post  B  which  carries  the  regulating  screw  G.  From  B  the  current 
goes  back  to  the  other  pole  of  the  battery,  which  is  represented  by 
the  battery-post  A1.  The  alternating  character  of  the  current  is 
shown  by  the  direction  of  the  arrows,  the  arrow  at  D  indicating 
the  direction  of  current  before  it  is  reversed  (arrow  at  B)  by  an 
interrupted.  The  diagram  of  the  secondary  coil  can  be  readily 
understood.  See  page  191.  (Bennett.) 


A  FARADIC-GALVAXIC  TABLE-PLATE. 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       183 


CHAPTER  VIII. 

THE  ELEMENTS  OF  ELECTRO-PHYSICS  AND 
ELECTRO-MECHANICS. 

MUCH  valuable  space,  time  and  energy  have  been  spent 
by  authors  and  practitioners  in  the  discussion  and  study  of 
electricity.  Electro-therapy  and  electricity  are  two  alto- 
gether different  things.  In  order  to  practice  electro-therapy 
successfully  and  scientifically,  it  is  not  necessary  to  be  an 
expert  electrician  or  electro-physicist.  A  man  may  be  a 
skillful  pianist  and  good  musician  without  knowing  much 
about  the  art  and  science  of  piano-building  or  the  physics  of 
sound.  The  drug-dispensing  physician  need  not  be  a  phar- 
macist or  a  pharmacologist.  The  essentials  in  the 
make-up  of  a  good  electro-therapeutist  are  a  genera.1  knowl- 
edge of  physiological  medicine,  of  electro-physiology 
and  enough  mechanical  knowledge  of  his  machines  and  their 
purposes  to  enable  him  to  operate  them  and  make  incidental 
repairs.  As  a  matter  of  fact,  a  good  electro-physicist  does 
not  necessarily  make  a  good  electro-therapeutist.  He  is 
prone  to  become  an  electrical  fanatic  and  is  likely  to  be  ac- 
cused of  riding  a  hobby.  In  this  way  he  is  certainly  not 
benefiting  either  the  cause  of  electro-therapeutics  or  of  gen- 
eral medicine  whose  servant,  not  mistress,  electricity  in  the 
hands  of  the  physician  should  be. 

I  shall  attempt  to  present  the  rudiments  of  electro- 
physics  and  electro-mechanics  as  briefly  and  simply  as  is 
consistent  with  intelligent  discussion  of  the  subject.  The 
magnetic  properties  of  amber  (electron)  were  noticed  by  the 
ancients,  who  named  the  mysterious  force  in  amber  elec- 
tricity. The  word  magnetism  is  probably  derived  from  the 


184  MODERN  PHYSIO-THERAPY. 

name  of  an  ancient  country,  Magnesia,  where  (magnetic) 
iron  ores  abounded.  Both  electricity  and  magnetism  were 
thought  to  be,  up  to  within  a  comparatively  recent  time,  im- 
ponderable fluids  that  were  too  fine  for  our  senses  to  per- 
ceive. These  fluids  were  supposed  to  flow  through  a  wire  or 
any  other  conductor  as  water  flows  through  a  pipe.  Our 
own  Benjamin  Franklin  held  this  view. 

Electricity  is  neither  a  fluid  nor  is  it  a  distinct  force 
which  can  be  separated  from  matter.  It  is  a  force-modality 
which  becomes  manifest  by  a  peculiar  state  of  matter  and 
consists  in  peculiar  vibrations  of  the  molecules  of  the  inter- 
posed ether.  The  knowledge  of  the  peculiar  states  of  mat- 
ter or  the  favorable  physical  conditions  which  give  rise  to 
manifestations  of  this  special  force-modality  is  the  science 
of  electro-physics.  We  look  upon  electricity  as  being  poten- 
tially omnipresent.  Our  knowledge  of  electro-physics  enables 
us  to  produce  the  physical  conditions  which  will  change 
the  potential  force  into  an  actual  force-modality.  Thus  we 
distinguish  between  potential  electricity  or  electricity  at 
rest,  and  actual  electricity  or  electricity  in  motion.  To  set 
anything. in  motion  there  must  be  sufficient  pressure  at  some 
point.  Water  would  remain  stationary  in  a  pipe  unless  pres- 
sure is  present  to  cause  it  to  move,  even  if  this  pressure  is 
only  the  force  of  gravitation.  Analogously,  there  must  be 
some  motive  power  to  cause  electricity  to  "flow."  This 
power,  which  is  the  vis  a  tcrgo  of  electrical  motion,  is 
known  as  the  electro-motive  force,  also  the  voltage,  the 
tension,  the  pressure  of  an  electrical  current.  A  unit  of 
electro-motive  force  is  known  as  a  volt. 

Water  running  out  of  a  faucet  may  be  measured  quan- 
titatively without  regard  to  the  speed  or  force  with  which 
it  is  running,  by  allowing  the  water  to  run  into  a  bucket, 
capable  of  holding  a  definite  quantity,  say  a  gallon.  When 
the  bucket  is  full,  we  call  the  quantity  of  water  contained  in 
the  bucket,  a  gallon  of  water.  It  may  run  out  in  two  min- 
utes or  in  an  hour.  It  is  a  measurement  of  quantity  pure 
and  simple.  If  we  measure  an  electric  current  in  an  analo- 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       185 

gous  way  without  regard  to  electro-motive  force  or  time  con- 
sumed, we  are  measuring  the  amount  of  current  pure  and 
simple.  A  unit  of  quantity  pure  and  simple  is  known  as  a 
coulomb. 

If,  in  meastiring  the  quantity  of  current,  we  wish  to  con- 
vey a  definite  statement  concerning  the  rate  at  which  a  unit 
of  quantity  is  "flowing,"  we  express  such  quantity  plus  rate 
of  flow  in  the  amperage  of  the  current.  A  unit  of  amperage 
is  'called  an  ampere.  It  represents  one  coulomb  passing  a 
given  point  during  one  second  of  time.  The  one-thousandth 
of  an  ampere  is  called  a  milliampere  and  is  the  unit  of 
measurement  which  is  used  in  electro-therapeutics.  The 
currents  commonly  used  in  medicine  have  very  low  am- 
perage. 

A  substance  carrying  or  capable  of  carrying1  electric 
currents  or  charges  is  called  a  conductor.  Not  all  sub- 
stances allow  an  electric  current  to  pass  through  them  with 
the  same  degree  of  facility.  Some  of  them  make  good  con- 
ductors, like  copper  and  most  metals ;  others  are  not  so 
good  (water,  graphite,  dry  wood,  etc.),  while  some  sub- 
stances do  not  transmit  or  carry  electricity  at  all  (glass, 
silk,  rubber,  etc.).  The  latter  are  known  as  insulators. 
The  less  resistance  a  substance  offers  to  the  passage  of  a 
current,  the  better  conductor  this  substance  would  be.  We 
gauge  the  conducting  quality  of  a  substance  by  the  degree 
of  resistance  it  offers.  The  resistance  offered  to  the  pas- 
sage of  a  current  is  an  item  of  some  importance.  A  unit  of 
resistance  is  called  an  ohm  (named  after  Dr.  G.  S.  Ohm, 
one  of  the  early  investigators  of  electricity).  If  a  certain 
conductor  offers  a  certain  amount  of  resistance,  it  stands  to 
icason  that  the  force  of  the  current  must  be  sufficiently  in- 
creased in  order  to  overcome  the  resistance.  If  a  certain 
amount  of  current  is  to  pass  a  given  point  in  a  certain  time, 
we  must  have  a  certain  amount  of  electro-motive  force.  To 
cause  one  ampere  (/.  e.  a  certain  quantity  in  a  second  of 
time)  of  current  to  overcome  one  ohm  of  resistance,  it  is 
necessary  to  have  an  electro-motive  force  of  one  volt.  If 


186  MODERN  PHYSIO-THESAPY. 

the  electro-motive  force  remains  one  volt,  the  amperage  of 
a  current  must  become  less  if  the  resistance  increases  and 
rice  versa.  The  three  factors,  voltage,  amperage  and  resist- 
ance, are  so  intimately  related  to  one  another  that  a  varia- 
tion in  one  necessarily  affects  the  other  two.  The  neces- 
sary relation  between  these  three  factors  was  expressed  by 
Dr.  Ohm  in  his  famous  law  (Ohm's  law}  which  states  that 
the  amperage  is  always  in  direct  proportion  to  the  voltage 
and  in  indirect  proportion  to  the  resistance.  By  knowing 
the  exact  amount  of  any  two  of  the  three  factors,  we  can 
figure  out  the  amount  of  the  remaining  one.  Ohm's  law  is 
expressed  in  the  forms  of  an  equation  thus: 

Amperage=voltage 

resistance 

Transposing  the  factors,  the  equation  would  read  : 


amperage 
Voltage=amperageX  resistance. 

An  ohm  is  approximately  equal  to  the  resistance  of  a 
copper  wire  250  feet  in  length  and  1-20  inch  in  thickness. 
An  instrument  which  will  change  a  current  of  a  certain 
amperage  and  voltage  into  a  current  of  different  amperage 
and  voltage  is  known  as  a  transformer. 

It  would  be  a  needless  expense  of  energy  to  go  into  the 
technical  details  of  the  general  subjects  so  far  touched  upon. 
It  is  not  our  aim  to  become  electricians  or  electro-physicists 
but  to  get  a  clear  conception  of  the  theoretical  part  of  the 
subject  as  far  as  the  practice  of  electro-therapy  requires  it. 
There  are  some  additional  minor  subjects  that  it  is  neces- 
sary to  discuss.  I  shall  present  them  in  a  brief  and  practical 
manner  under  special  heads. 

How  VOLTAGE  is  PRODUCED.  —  Electro-motive  force  is 
principally  generated  by  either  chemical  action  (cells  of 
various  kinds)  or  by  mechanical  energy  (dynamos,  static 
machines). 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       187 

Chemical  Action. — If  a  piece  of  zinc  and  a  piece  of 
copper  are  partly  immersed  in  a  weak  solution  of  sulphuric 
acid,  a  current  of  electricity  will  flow  from  the  copper  to 
the  zinc.  The  electrical  energy  is  the  direct  product  of  the 
chemical  action  set  up.  The  pieces  of  zinc  and  copper  are 
known  as  the  elements,  while  the  medium  in  which  they  are 
immersed  and  in  which  the  chemical  action  takes  place  is 
known  as  the  electrolyte.  The  jar,  receiver  or  container, 
including  the  elements  and  the  electrolyte,  is  known  as  a 
cell.  A  number  of  cells  properly  joined  together  is  called 
a  battery.  The  parts  of  the  elements  which  are  outside  of 
the  electrolyte,  are  called  the  terminals.  The  exposed  part 
of  an  element  is  opposite  in  polarity  to  the  immersed  por- 
tion, i.  e.  if  the  immersed  portion  is  positive,  the  exposed 
part  of  the  same  element  is  negative.  When  we  speak  of 
the  positive  or  negative  pole  of  a  cell,  we  always  refer  to 
the  exposed  parts  of  the  elements  or  to  the  terminals  proper. 
If  zinc  is  the  negative  element  of  a  cell,  it  is  the  exposed  part 
or  the  terminal  of  the  zinc  that  is  referred  to  as  being  nega- 
tive. The  negative  terminal  always  belongs  to  the  element 
which  is  acted  upon  by  the  electrolyte.  If  the  electrolyte  is 
a  liquid,  the  cell  is  known  as  a  wet  cell ;  if  it  is  held  in  the 
pores  of  some  porous  solid,  the  cell  is  called  a  dry  cell. 
When,  owing  to  the  collection  of  hydrogen  on  one  of  the 
elements,  the  electrolyte  is  no  longer  active,  the  cell  is  said 
to  be  polarized.  Any  agent  by  which  polarization  is  re- 
moved is  known  as  a  depolarizer.  The  decomposition  of 
liquids  by  means  of  electricity  is  called  electrolysis.  The 
atoms  set  free  are  called  ions.  The  element  from  which  the 
electric  energy  emanates  toward  the  liquid  is  called  the 
positive  element  or  anode,  the  liberated  atoms  traveling  in 
this  direction  being  known  as  onions.  The  element  which 
draws  the  energy  away  from  the  decomposing  fluid  is 
known  as  the  negative  terminal  or  cathode,  the  atoms  travel- 
ing in  the  direction  indicated  being  known  as  cathions. 
There  are  many  different  varieties  of  both  wet  and  dry  cells. 
An  apparatus  in  which  electric  energy  is  accumulated  which 


188  MODERN  PHYSIO-THERAPY. 

can  be  liberated  in  the  form  of  an  electric  current  is  known 
as  an  accumulator,  a  secondary  battery  or  a  storage-battery. 
Electricity  generated  by  wet,  dry  and  storage-cells  is  said 
to  be  produced  by  chemical  action. 

Mechanical  Energy. — If  a  piece  of  metal  has  the  con- 
stant property  of  attracting  or  repelling  other  bodies  it  is 
called  a  natural  magnet,  the  property  of  attraction  and  re- 
pulsion being  known  as  magnetism.  If  this  property  is  tem- 
porarily produced  in  a  piece  of  metal  by  the  passage  of  an 
electric  current  near  or  around  the  metal  we  speak  of  an 
electro-magnet  and  electro-magnetism.  The  magnet  is  sur- 
rounded by  a  field  of  magnetic  force  known  as  the  magnetic 
field.  By  placing  a  conductor  in  the  field  of  force  surround- 
ing a  magnet,  a  current  of  electricity  can  be  generated.  By 
placing  a  piece  of  suitable  metal  inside  of  a  coil  of  wire  car- 
rying a  current  of  electricity,  the  metal  will  become 
magnetic  and  remain  so,  as  long  as  the  current  "flows." 
The  current  magnetizes  the  metal  (metallic  core).  When 
the  current  stops,  the  metal  becomes  demagnetised.  To 
produce  magnetism  by  an  electric  current  and  to  generate 
electricity  by  magnetism  is  made  possible  by  the  close  mutual 
relationship  existing  between  the  two  force-modalities.  It 
:s  another  illustration  of  the  physical  phenomenon  which 
consists  in  the  changing  of  one  force-modality  into  another 
force-modality  (Kraftumwerthung).  The  two  instances 
quoted  are  of  the  utmost  practical  value  and  importance  be- 
cause they  contain  the  principles  which  underlie  the  modern 
dynamo,  and,  in  a  somewhat  varied  sense,  the  so-called 
electro-static  induction-machine.  The  electricity  generated 
by  these  different  apparatus  is  said  to  be  produced  by  me- 
chanical energy. 

DIFFERENT  KINDS  OF  ELECTRIC  CIRCUITS. — An  electric 
circuit  is  the  path  of  the  electric  current  from  one  terminal 
of  the  generating  source  through  various  conductors  back 
to  the  other  terminal  of  the  generating  source.  As  long  as 
the  electric  current  flows,  the  circuit  is  said  to  be  closed ; 
if  a  break  occurs,  the  electric  circuit  is  said  to  be  open  and 


/  SERIES  LAMP 


1)1  \GRAM   SHOWING  MANNER  OF  WIRING  A 
GRAPHITE-RHEOSTAT. 


A  MILLIAMPEREMETER 


190  MODERN  PHYSIO-THERAPY. 

the  current  ceases  to  flow.  If  the  ground  or  earth  is  a  part 
of  an  electric  circuit,  the  latter  is  spoken  of  as  a  grounded 
circuit  (frequently  employed  in  static  electricity).  Some- 
times a  circuit  is  split  up  into  branches  or  smaller  circuits. 
A  branch  of  a  divided  circuit  of  this  kind,  carrying  electric 
energy  and  being  really  a  part  of  the  circuit,  is  called  a 
shunt.  If  the  cells  composing  a  battery,  are  joined,  the  posi- 
tive element  of  one  cell  connecting  with  the  negative  ele- 
ment of  the  next  cell,  the  cells  are  said  to  be  arranged  in 
scries.  If,  on  the  other  hand,  the  positive  elements  of  the 
cells  are  joined  together  by  wires  which  form  one  common 
conductor  and  the  negative  cells  are  likewise  joined  and 
form  one  common  conductor,  the  cells  are  said  to  be  ar- 
ranged in  multiple  or  in  parallel.  The  terms  "in  series"  or 
"in  multiple"  ("in  parallel")  are  used  in  an  analogous  way 
in  regard  to  any  kind  of  electrical  attachment  or  apparatus. 
Whenever  motors,  incandescent  lamps,  etc.,  are  put  in  a  cir- 
cuit, they  are  wired  "in  series"  or  "in  multiple,"  the  mean- 
ing of  the  two  terms  being  the  same  as  suggested  in  regard 
to  the  wiring  of  cells.  A  short  circuit  is  a  circuit  which  is 
complete  before  it  reaches  the  conductors.  If,  while  a  pa- 
tient is  receiving  a  static  treatment,  e.  g.  a  crown  breeze, 
we  were  to  bring  the  terminals  of  the  machine  (horizontal 
sliding  rods)  together,  the  patient  would  not  get  any  more 
electricity  because  the  machine  is  short-circuited,  i.  e.  the 
circuit  is  complete  before  the  current  reaches  the  conductors 
which  carry  the  current  to  the  patient. 

DIRECT  AND  ALTERNATING  CURRENTS. — Whenever  there 
is  constant  pressure  (electro-motive  force)  in  one  direction, 
the  current  is  known  as  a  direct  current.  If  the  pressure 
(electro-motive  force)  changes  from  one  direction  to  the 
other,  the  current  is  called  an  alternating  current.  The 
pressure  begins  at  the  zero-mark  (no  potential  difference) 
and  rises  until  it  has  reached  the  maximum  and  drops  down 
to  zero  and  beyond  it,  i.  e.  it  exerts  pressure  in  the  opposite 
direction  until  it  has  reached  its  full  degree  of  tension.  It 
again  returns  to  the  neutral  point  and  the  same  process  as 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       191 

before  is  gone  through.  The  voltage  of  such  a  current 
might  be  represented  by  a  curve  or  rather  a  double  curve, 
one  above  and  the  next  one  following  it  below  a  neutral 
ievel.  Each  curve  is  called  an  alternation.  Two  successive 
alternations  constitute  a  cycle.  The  time  consumed  in  the 
completion  of  a  cycle  is  called  a  period.  The  number  of 
alternations  which  occur  in  one  second  is  called  the  fre- 
quency of  the  current.  Thus,  a  high-frequency  current  is 
one  which  is  characterized  by  the  high  number  of  cycles 
which  are  completed  in  one  second.  The  number  may  reach 
into  the  thousands  and  millions. 

INDUCTION. — If  a  body  holding  an  electrical  charge  or  a 
conductor  carrying  an  electric  current  causes  electrical 
phenomena  (attraction,  repulsion,  current)  to  appear  in 
neighboring  bodies  which  are  in  no  way  connected  with  the 
electrified  body  or  conductor,  such  phenomena  are  said  to 
be  produced  by  induction.  Induction,  therefore,  is  an  in- 
fluence by  which  electrical  phenomena  are  produced  without 
contact.  The  large  balls  in  front  of  a  static  machine  will 
attract  bits  of  paper  and  other  small  bodies  or  repel  them, 
showing  that  there  must  be  a  sphere  or  a  field  of  electrical 
influence  around  these  accumulators  of  static  electricity.  If 
a  wire  is  brought  near  another  wire,  the  latter  carrying  an 
electrical  current,  at  once  there  will  be  an  electrical  current 
set  up  in  the  wire  which  is  brought  near  it.  This  shows  that 
the  wire  carrying  a  current  is  surrounded  by  a  field  of  in- 
fluence which  charges  bodies  or  wires  without  there  being 
any  contact  with  the  wire  which  carries  the  current.  The 
influence  which  produces  these  phenomena,  is  called  induc- 
tion. Charges  or  currents  produced  by  induction  are  known 
as  induced  or  secondary  charges,  induced  or  secondary  cur- 
rents. The  sphere  of  magnetic  influence  around  a  magnet  is 
known  as  the  magnetic  field.  If  a  magnetizable  substance  is 
brought  within  this  magnetic  field,  it  will  become  magnetic. 
The  influence  producing  this  phenomenon  is  called  magnetic 
induction.  Faraday  took  a  core  of  iron,  insulated  it  per- 
fectly and  wound"  a  coil  of  wire  over  the  insulated  core.  He 


192  MODERN  PHYSIO-THERAPY. 

then  covered  the  ceil  of  wire  with  an  insulating  substance 
and  wound  another  wire  over  this  insulation.  By  allowing 
a  current  to  pass  through  the  wire  covering  the  core,  the 
core  became  magnetic  and  another  current  was  set  up  in 
the  outside  .wire.  The  current  in  the  outside  wire  is  known 
as  the  induced  or  secondary  current.  This  is  the  principle 
of  the  faradic  coil.  Another  pertinent  example  of  induction 
is  the  appearance  of  a  current  in  the  outer  armature  of  a 
Ley  den  jar,  there  being  no  contact  between  the  outer  and 
inner  coating  of  the  jar.  The  current  in  the  outer  coating 
is  an  induced  or  secondary  current. 

POLARITY. — Electricity,  although  it  is  universally  pres- 
ent, becomes  an  actual  force-modality  as  soon  as — by  chem- 
ical action  or  by  mechanical  energy — the  state  of  latency  or 
neutrality  is  disturbed.  The  action  which  sets  a  current  in 
motion  in  a  cell,  takes  place  between  two  suitable  elements 
immersed  in  a  suitable  medium.  It  disturbs  the  potential  or 
the  level  of  the  energy  and,  as  a  result,  a  current  flows  from 
the  higher  level  to  the  lower  one.  The  higher  level  is  called 
the  positive  element  or  positive  pole  (anode),  the  lower 
level  is  known  as  the  negative  element  or  negative  pole 
(cathode). 

COMMON  ELECTRICAL  TERMS. — Binding  posts  are 
clamps,  thumb-screws  or  any  kind  of  device  by  which  con- 
ducting wires  are  attached  to  an  electrical  apparatus.  A 
pole-changer  (polarity-switch,  current-reverser,  rheotrope) 
is  a  device  for  changing  the  direction  of  a  current  without 
disturbing  the  conductors.  Electrodes  are  the  instruments 
which  are  attached  to  an  electrical  apparatus  by  means  of 
cords  or  wires  and  by  which  electricity  is  applied  to  the 
human  body.  Electrodes  may  be  sponge-handles,  metallic 
handles,  brushes,  rollers,  large  or  small  metallic  balls,  large 
or  small  crowns,  needles,  etc.,  etc.,  etc.  A  rheostat  is  an 
instrument  by  which  a  definite  amount  of  resistance  is 
brought  into  the  path  of  an  electric  current.  Practically, 
therefore,  it  is  an  instrument  by  which  the  strength  of  a 
current  can  be  increased  or  diminished.  A  rheotome  is  an 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       193 

instrument  by  which  an  electrical  circuit  is  completely 
broken.  An  ammeter  is  an  instrument  by  which  the  am- 
perage of  a  current  is  measured.  If  the  current  is  of  very  low 
amperage  (e.  g.  less  than  one  ampere)  an  instrument,  called 
juilliamperemeter  is  used,  which  measures  the  strength  of 
the  current  in  milliamperes.  A  switch  is  a  device  consisting 
of  metallic  bars  movable  on  a  pivot,  used  for  the  purpose  of 
connecting  or  disconnecting  conductors  or  of  changing  the 
path  of  an  electrical  current  by  turning  it  into  a  different 
conductor. 

ELECTRO-THERAPEUTIC  CURRENTS.  —  There  are  four 
kinds  of  electric  currents  used  in  medicine  to-day,  to  wit : 
(i)  the  constant  (galvanic,  continuous)  current  which  is 
generated  by  wet  or  dry  cells  or  by  some  form  of  mechan- 
ical energy  (central  lighting  and  power  station) — it  is  a 
current  of  a  given  maximum  amperage  and  traveling  in 
one  direction  with  certain  pressure;  (2)  the  interrupted 
(faradic)  current,  which  is  obtained  by  passing  a  constant 
current  through  an  insulated  coarse  wire  wound  around  an 
insulated  piece  of  iron  or  a  core  made  up  of  a  bundle  of 
pieces  of  iron-wire  of  equal  length.  The  moment  a  current 
passes  through  the  coil  of  wire  wound  around  the  iron-core, 
the  latter  becomes  magnetic  and  the  lines  of  magnetic  force 
which  surround  it  permeate  the  convolutions  of  wire  around 
the  magnetic  core.  The  result  is  a  rise  in  the  electro-motive 
force.  The  little  hammer  which  is  mounted  on  a  flat  metal- 
lic spring  and  is  stationed  at  one  end  of  the  core,  is  attracted 
towards  the  core  the  moment  the  latter  becomes  magnetic. 
The  back  of  the  flat  metallic  spring  is  in  contact,  or  nearly 
so,  with  a  platinum-point  between  which  and  the  spring  the 
electric  spark  passes.  When  the  hammer  is  in  contact  with 
the  core,  the  circuit  of  electricity  is  broken,  because  the 
metallic  spring  is  drawn  away  from  the  platinum-point  and 
no  spark  passes  as  a  result.  This  is  followed  by  demag- 
netization of  the  core.  The  hammer  is  no  longer  held  by 
the  core,  but  returns  to  its  original  position,  thereby  re-es- 
tablishing current  in  the  coil  of  wire  and  magnetism  in  the 


194  MODERN  PHYSIO-THERAPY. 

core.  The  magnetism  in  the  core  again  causes  the  hammer 
to  be  attracted  and  thus  the  current  to  be  broken.  It  is  a 
constant  make  and  break  of  current  and  a  coincident  mag- 
netization and  demagnetization  of  the  core.  The  moment 
magnetization  occurs,  electro-motive  force  is  generated  in 
the  wire  surrounding  the  core.  At  the  moment  of  demag- 
netization the  direction  of  electro-motive  force  of  the  cur- 
rent is  reversed.  The  coarse  wire  which  is  wound  around 
the  core  is  known  as  the  primary  wire,  and  the  current 
which  it  carries,  as  the  primary  current.  The  coil  of  fine 
wire  wound  around  the  insulated  primary  coil  is  known  as 
the  secondary  u'ire.  This  wire  is  in  the  magnetic  field  of 
the  core  and  of  the  primary  wire.  The  moment  a  current  is 
generated  in  the  primary  wire,  there  is  an  induced  or  sec- 
ondary current  in  the  secondary  wire.  According  to  an 
established  electrical  law  the  induced  current  travels  in  a 
direction  opposite  to  that  of  the  primary  current.  There 
are  the  same  alternations  of  electro-motive  force,  only  in 
the  reversed  order.  Every  twist  of  wire  situated  in  a  mag- 
netic field  cuts  the  lines  of  magnetic  force  and  increases  the 
voltage.  Owing  to  the  greater  number  of  convolutions  of 
fine  wire  in  the  secondary  coil  as  compared  to  the  number  of 
twists  of  coarse  wire  in  the  primary  wire,  the  electro-motive 
force  produced  by  breaking  the  lines  of  magnetism  is  neces- 
sarily much  higher  in  the  secondary  current  than  in  the 
primary.  The  hammer-attachment  is  what  gives  to  this  cur- 
rent its  interrupted  character.  The  presence  of  the  mag- 
netized core  accounts  for  the  increase  in  voltage.  Thus  the 
faradic  current  is  a  galvanic  current  modified  by  the  laws  of 
magnetism  and  induction.  To  interrupt  a  galvanic  current 
by  a  switch  or  by  means  of  rheotome  does  not  make  a  fa- 
radic current  out  of  it.  A  faradic  current  is  properly  known 
as  an  interrupted  current.  A  galvanic  current  frequently 
broken  by  means  of  a  rheotome  is  known  as  an  interrupted 
galvanic  current.  (3)  The  static  current,  generated  by 
friction  and  variously  known  as  Franklinic  or  frictional 
electricity,  has  recently  risen  to  a  high  plane  of  therapeutic 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       195 

usefulness.  It  is  produced  by  the  static  machine,  of  which 
there  are  several  types,  which  differ  in  their  physical  prin- 
ciples and  mechanical  construction.  The  static  machine 
will  be  discussed  under  a  separate  heading.  The  static  cur- 
rent is  one  of  intense  electro-motive  force,  the  number  of 
volts  rising  into  the  thousands,  while  the  amperage  is  very 
low.  (4)  The  high-frequency  current  is  an  alternating  cur- 
rent characterized  by  a  very  high-frequency  of  alternations 
(500,000  and  more  per  second).  High-frequency  currents 
may  be  applied  in-  various  ways.  The  therapeutic  impor- 
tance of  the  subject  justifies  its  separate  discussion  under  a 
special  head.  The  so-called  sinusoidal  current,  which  is  an 
alternating  current  and  is  hardly  ever  used  by  electro- thera- 
peutists nowadays,  is  generated  by  an  armature  or  coil 
which  is  rapidly  revolved  within  the  magnetic  field  of  an- 
other coil  and  core. 

The  electro-mechanical  education  of  an  electro-thera- 
peutist consists  largely  in  the  knowledge  of  the  apparatus 
and  machines  which  are  used  for  the  purpose  of  generat- 
ing the  constant,  interrupted,  static  and  hyper-static  (high- 
frequency  )  currents  and  in  the  possession  of  skill  taking  care 
of  and  operating  these  machines.  Modern  electro-therapy 
has  eliminated  many  of  the  cumbersome  mechanical  devices 
which  were  en  vogue  years  ago.  The  constant  and  inter- 
rupted currents  are  usually  furnished  by  a  combined  switch- 
board (wall-plate,  table-plate,  galvano-faradic  cabinet), 
which  is  connected  with  the  street-circuit  or  supplied  with 
cells.  The  switch-boards  (galvano-faradic  wall-plates)  are 
to  all  intents  and  purposes  variations  of  the  same  original 
type.  Some  may  be  richer  in  finish  and  more  pretentious  in 
technical  construction.  The  addition  of  attachments  for 
diagnostic  lamps  and  cautery  has  enhanced  their  usefulness 
very  materially.  From  a  strictly  electro-therapeutic  point 
of  view  their  value  consists  in  their  aptitude  to  furnish  gal- 
vanic and  faradic  currents  and  to  enable  the  operator  to 
modify  the  administration  of  these  currents  in  keeping  with 
his  clinical  purpose. 


196 


MODERN  PHYSIO-THERAPY. 


THE  GALVANIC-FARADIC  SWITCHBOARD. 
The  switchboard,  which  is  in  general  use  for  the  purpose 
of  controlling  the  constant  (galvanic)  and  the  interrupted 
(faradic)  current,  has  the  form  of  a  wall-plate,  roller-cab- 


A  FARADIC-GALVANIC  ROLLER  CABINET. 

inet  or  table-plate.  The  electricity  which  is  supplied  to  this 
switchboard  is  generated  and  furnished  either  by  primary 
(wet  or  dry)  batteries,  secondary  (storage)  batteries  or 
by  the  central  lighting  supply  (street-current). 


c. 


A.  Two  sets  of  tips  and  handles.  B.  Straight  and  curved  vaginal  electrode. 
C.  Bipolar  uterine  electrode.  D.  Uterine  cup  and  stem  electrode.  E.  Uterine  copper 
electrodes.  F.  Rectal  electrode. 


198  MODERN  PHYSIO-THERAPY. 

For  the  control  and  regulation  of  the  current,  which 
must  be  of  sufficient  quantity  and  of  proper  electro-motive 
force,  the  switchboard  is  supplied  with  a  rheostat  and  with 
selector-switches.  If  the  current  is  supplied  by  the  street- 
circuit,  a  controller  in  the  form  of  one  or  more  incandes- 
cent lamps  regulates  the  amount  of  current  received. 

In  order  to  adapt  the  amount  of  the  available  current  to 
the  requirements  of  therapeutic  work,  the  strength  of  the 
current  is  modified  by  means  of  a  rheostat.  The  rheostat  is 
an  instrument  which  enables  the  operator  to  introduce  any 
desirable  amount  of  resistance  and  to  lessen  the  current- 
strength  accordingly.  The  best  rheostat  is  made  of  coils  of 
German-silver  wire.  A  fairly  good  and  much  cheaper  in- 
strument is  the  graphite  rheostat.  The  graphite  rheostat 
has  a  handle,  the  movement  of  which  influences  the  amount 
of  current. 

The  so-called  selector-switches  enable  the  operator  to 
select,  by  proper  use  of  a  special  switch,  the  kind  of  current 
he  desires,  e.  g.  a  constant  (galvanic)  current  or  a  primary 
or  a  secondary  interrupted  (faradic)  current,  as  the  case 
may  be. 

It  is  impossible  to  do  exact  therapeutic  work  with  the 
constant  (galvanic)  current  without  being  able  to  measure 
the  amperage  of  the  current  used.  An  instrument  which 
is  used  for  this  purpose  is  called  an  ammeter.  Since,  how- 
ever, the  amperage  of  a  therapeutic  constant  current  hardly 
ever  exceeds  one-half  of  an  ampere  (500  milliamperes),  an 
instrument  for  measuring  minute  quantities  of  current  is 
used.  An  instrument  of  this  kind  is  called  a  milliampere- 
meter.  One  of  the  types  of  milliamperemeter  ordinarilv 
used  consists  of  a  needle  which  turns  freely  on  a  pivot  and  is 
connected  with  a  magnet  which  is  influenced  by  the  earth's 
magnetism.  A  coil  of  wire  which  is  parallel  to  the  magnet 
is  traversed  by  an  electric  current,  the  result  being  deflection 
of  the  needle  away  from  the  earth's  magnetic  meridian.  An- 
other type,  known  as  D'Arsonval's  milliamperemeter,  con- 
sists of  a  powerful  permanent  magnet,  between  the  poles  of 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       199 


D. 


A.  Roller  electrode,  hard  rubber,  set  with  metallic  points,  for  muscular 
faradization,  with  current  interrupter.  B.  Bennett's  multiple  needle-holder. 
C.  Brush  electrode.  D.  Bennett's  abdominal  electrode. 


200  MODERN  Pnvsio-Tui  R APV. 

which  a  core  of  soft  iron,  surrounded  by  a  coir  of  wire,  is 
suspended.  An  indicating  needle  is  attached  to  this  coil. 
When  a  current  passes  through  the  coil,  the  latter  will  tend 
to  take  a  position  at  right  angles  to  the  poles  of  the  perma- 
nent magnet.  "This  causes  the  needle  to  move  over  an  indi- 
cating scale.  The  scale  may  be  single  or  double.  By  being 
able  to  regulate  the  circuit  in  the  milliamperemeter  (usually 
by  means  of  a  plug-attachment),  a  fine  and  a  coarse  scale 
can  be  used  to  great  advantage. 

Sometimes  it  is  desirable  to  interrupt  the  galvanic  cur- 
rent and  administer  it  in  the  form  of  shocks  of  suitable 
severity  and  rapidity.  The  relative  rapidity  of  these  shocks 
is  determined  by  an  instrument  called  a  rheotome,  of  which 
there  are  several  types.  Probably  the  best  known  is  the 
clock-work  rheotome. 

The  polarity  of  the  switchboard  depends  on  the  polarity 
of  the  current  supplying  it.  The  two  wires  carrying  the 
current  from  the  street  or  from  the  cells  are  respectively 
positive  and  negative.  In  installing  the  switchboard  it  is  of 
vital  significance  to  wire  it  with  proper  regard  to  the  polarity 
of  the  supply-wires.  Each  switchboard  is  supplied  with  a 
polarity-switch  (pole-changer).  Connect  the  switchboard 
with  the  supply-wires  and  attach  the  conducting  cords  (i.  e. 
the  cords  which  are  used  in  giving  treatment).  Place  the 
metal-tips  of  these  cords  in  a  glass  of  salt-water  after  the 
current  has  been  turned  on.  The  negative  current  will  de- 
compose the  water  and  cause  bubbles  of  gas  to  accumulate 
on  the  metal  tip  of  the  negative  wire.  Notice  the  position 
of  the  polarity-switch  (pole-changer)  and  see  whether  the 
handle  of  the  switch  is  on  the  left  or  the  right  side.  You 
have  already  found  out  which  one  of  the  conducting  cords 
i?  carrying  the  negative  current.  Notice  whether  the  cord 
is  on  the  left  or  right  side.  This  will  tell  you  which  side  of 
the  polarity-switch  is  negative  (i.  e.  the  side  of  the  negative 
cord).  The  opposite  side  is  necessarily  positive.  By  bring- 
ing the  handle  of  the  polarity-switch  over  to  the  other  side, 
you  will  reverse  the  order  of  things,  making  the  heretofore 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       201 

positive  side  negative  and  the  heretofore  negative  side  posi- 
tive. This  is  why  the  polarity-switch  is  frequently  called  the 
pole-changer.  Sometimes  the  pole-changer  is  marked  ''posi- 
tive." This  is  to  say  that  the  side  of  the  pole-changer-handle 
is  to  be  the  positive  side  of  the  switchboard.  In  order  to 
have  it  so,  the  supply-wires  (from  cells  or  street)  must  be 


Eustachian  electrode  devised  by  Dr.  C.  R.  Holmes, 
of  Cincinnati,  O. 


Eye  electrode  devised  by  Dr.  C.  R.  Holmes,  of  Cincinnati,  O. 


Rectal  hydro-galvanic  electrode  devised  by  Dr.  Louis  J.  Krouse,  of 
Cincinnati,  O. 


Newman's  urethral  hydro-galvanic  electrode. 

attached  accordingly.    The  salt-water  test  should  invariably 
be  made. 

Every  switchboard  has  a  faradic  induction-coil  for 
the  production  of  the  interrupted  (faradic)  current.  Its 
construction  has  already  been  referred  to.  The  interrup- 
tions may  be  coarse  or  fine,  depending  on  the  character  of 
the  interrupting  device  ("vibrator").  There  are  several  of, 
the  latter  en  rogue.  Some  coils  are  supplied  with  a  differ- 
ent kind  of  a  vibrator  at  each  end  of  the  core.  The  different 
currents  coming  from  the  faradic  coil  may  be  decreased  or 


202  MODERN  PHYSIO-THERAPY. 

increased.  They  may  be  coarsely  interrupted  by  a  rheotome. 
i'aradic  current  is  not  measured  by  a  milliamperemeter. 

In  addition  to  the  parts  mentioned  a  switchboard  may 
be  equipped  with  additional  controllers,  voltmeter,  attach- 
ments for  diagnostic  lamps  and  cautery. 

The  conducting  cords  are  made  of  fine  copper  wire  or 
brass  tinsel,  cotton  or  silk  covered.  They  should  be  strong, 
durable  and  pliable.  They  terminate  in  metal  tips,  which 
are  attached  to  the  binding-posts  on  the  switchboard,  the 
free  ends  being  connected  to  the  electrodes,  of  which  there  is 
an  unending  variety.  The  work  which  an  operator  pro- 
poses to  do,  determines  the  kind  of  electrodes  he  is  to  use, 
e.  g.  sponge-electrodes,  metal  handles,  electrolytic  needles, 
uterine,  urethral,  rectal,  nasal,  laryngeal  electrodes,  etc. 

The  Static  Machine. 

The  common  type  of  static  machine  in  use  in  this  coun- 
try is  constructed  after  the  models  originated  by  the  two 
physicists  Toepler  and  Holtz,  and  contains  the  physical  prin- 
ciples of  their  machines.  For  any  detailed  discussion  and 
description  of  the  subject  see  any  good  text-book  on  physics. 

The  generation  of  static  electricity  in  the  ordinary  Toep- 
ler-Holtz  machine  takes  place  by  friction  (tinsel-brushes 
against  brass  knobs),  conduction  along  the  metal  frame- 
work and  induction  on  the  glass-plates. 

The  plates  (glass,  mica,  rubber)  are  stationary  and  re- 
volving. The  revolving  plates  move  in  a  direction  opposite 
to  the  movement  of  the  hands  of  a  watch,  i.  e.  from  right 
to  left.  The  size  of  the  plates  determines  the  voltage,  the 
number  of  the  plates  the  amperage  of  the  current.  The 
discharge  of  the  electric  current  takes  place  in  front  of  the 
machine  between  two  small  balls  which  represent  the  ter- 
minals of  two  horizontal  sliding  rods.  The  distance  between 
these  balls  determines  the  length  of  the  spark. 

A  static  machine  should  be  kept  free  from  dust  and 
moisture.  A  dry  clean  machine  ought  to  work  in  all  kinds 
of  weather  and  in  any  climate.  The  outside  of  the  case 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       203 

should  receive  a  dry  cleaning  (soft  rag)  every  morning. 
The  metal  parts  should  be  polished.  Alcohol  should  be 
used  sparingly.  It  has  a  tendency  to  take  the  lacquer  off  the 
metal.  A  dry  polish-powder  is  preferable.  Every  two  or 
three  weeks  the  case  should  be  washed  with  soap  and  water, 


A   MODERN   TOEPLER-HOLTZ   MACHINE. 

and  afterwards  carefully  dried.  The  inside  of  the  case 
should  be  ventilated  once  or  twice  a  week  on  dry  bright  days. 
The  case  and  the  plates  should  be  wiped  with  a  soft  dry 
rag  (silk).  By  wrapping  the  rag  around  a  stick  and  hold- 


204 


MODERN  PHYSIO-THERAPY. 


SKELETON  OF  A  STATIC  MACHINE. 

1,  Upper  cross-bar  with  washers.  2,  Lower  cross-bar  with 
washers.  3,  Flange.  4,  Comb-bracket.  5,  Bracket  with  combs  and 
plate-holders.  6,  Bracket  with  plate-holders.  7,  Plate-holders. 
8,  Oil-cup.  9,  Brush-holder.  10  and  11,  Special  X-ray  posts  on 
some  machines.  12,  Main  post.  13,  Large  brass  ball  (collector). 
14,  Small  brass  ball.  15,  Sliding  rod.  16  and  17,  Leyden  jars. 
18,  19,  20  and  21,  Attachment  for  turning  machine  by  hand. 
22,  Curent-controller  (of  questionable  utility).  23,  Switch  and 
current-indicator  (on  'Some  machines).  24,  Base  of  Leyden  jar. 
25,  Flanges  on  both  .sides  of  the  glass.  26,  Washer.  27,  Brass  top 
of  main  posts.  28,  Oil-cup.  29,  Hub  on  main  shaft.  30,  Glass 
plates.  31,  Support  for  stationary  plates.  32,  Bracket  for  crank- 
shaft. 33,  Bracket  for  brushes  and  plate-holders.  (Bciincit.) 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       205 

ing  the  latter  between  the  slowly  revolving  plates,  the  dust 
from  the  latter  is  easily  removed.  Sometimes  it  is  neces- 
sary to  slightly  moisten  the  rag  with  alcohol  before  it  is 
possible  to  remove  the  layer  of  dirt  from  the  plates.  If, 
after  thoroughly  cleaning  the  machine,  the  latter  refuses  to 
work,  the  trouble  is  due  to  moisture  and  the  operator  must 
resort  to  some  artificial  way  of  drying  the  inside  of  the  case. 
H.  C.  Bennett  gives  the  following  directions  for  the  use  of 
ice  and  salt:  "Take  a  one-quart  glass  fruit- jar  with  screw 
top,  fill  with  a  mixture  of  powdered  ice  and  rock-salt,  screw 
down  the  cover  and  wipe  the  moisture  from  the  outside  of 
the  jar;  place  the  jar  in  a  saucer  or  bowl  inside  the  case  of 
static  machine,  close  the  door  and  set  the  machine  in  mo- 
tion, keeping  the  plates  moving  until  the  machine  begins  to 
generate  at  its  best.  After,  say  an  hour,  when  the  ice  is 
fairly  melted,  remove  the  jar  and  quickly  close  the  end  door 
so  as  to  prevent  the  outside  air  from  getting  into  the  case." 

By  all  odds  the  simplest,  cleanest  and  most  effective  way 
of  drying  the  inside  of  a. static  machine  is' the  use  of  five  or 
ten  pounds  of  fused  chloride  of  lime-  (dry,  hard  lumps)  in 
one  or  more  earthen  or  porcelain  dishes.  The  lime  is  mark- 
edly hygroscopic.  The  operator  ought  to  watch  the  con- 
ditions of  moisture  in  the  case.  A  little  cheap  instrument, 
called  a  hygrometer,  hung  in  the  case,  is  very  serviceable. 
Frequently  the  machine  can  be  started  by  simply  making  a 
fire  in  the  room. 

The  static  machine  can  be  operated  by  hand  or  by  dif- 
ferent kinds  of  power  (water,  electric).  The  best  way  of 
driving  a  machine  is  to  run  it  by  means  of  a  good  one-third 
horse-power  electric  motor. 

The  current  which  is  generated  by  a  static  machine  is 
one  of  high  voltage.  It  has  been  determined  experimentally 
that  it  requires  approximately  8,000  volts  to  produce  a  spark 
one  inch  in  length.  There  are  three  modes  of  static  dis- 
charge. If  the  electric  energy  travels  along  a  conductor, 
c.  g.  a  brass  rod  held  by  the  hand  of  the  patient,  the  current 
is  discharged  into  the  hand  of  the  patient  directly  as  though 


206 


MODERN  PHYSIO-THKRAPY. 


the  hand  were  a  part  of  the  conductor,  which,  in  reality,  it 
is.  This  is  a  conductive  discharge  (conduction).  Helm- 
holtz  assumed  that  the  atoms  of  atmospheric  air  surround- 
ing' the  surface  of  a  highly  charged  conductor  are  dislodged 
and  carry  off  minute  charges  of  electricity.  This  takes  place 
when  the  collecting-combs  in  the  static  machine  discharge 


A  HOLTZ  INFLUENCE  MACHINE. 

toward  the  revolving  plates.  This  mode  of  discharge  is 
called  connective  discharge  (convection).  This  is  the 
physics  of  the  so-called  static  breeze  or  spray  to  be  consid- 
ered hereafter.  If  the  convection  takes  place  in  the  form 
of  a  faintly  luminous  discharge  from  a  pointed  or  small 
rounded  positive  conductor,  it  is  known  as  a  brush-dis- 
charge. If  the  electric  discharge  occurs  suddenly  across  an 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       207 

intervening  non-conductor  it  is  called  a  disruptive  discharge 
(disruption),  and  assumes  the  form  of  a  spark.  The  non- 
conductor interposed  between  two  conductors  (e.  g.  the  air 
between  the  terminals  of  a  static  machine  or  the  glass  be- 
tween the  inner  and  the  outer  coating  of  a  Leyden  jar)  is 
called  the  dielectric. 

The  mode  of  discharge  is  in  no  inconsiderable  manner 
influenced  by  the  surface  whence  it  is  given  off.  Even  and 
uniform  surfaces  accumulate  static  electricity  and  for  this 
reason  favor  disruptive  discharges  (sparks).  In  order  to 
administer  static  sparks  to  a  patient,  the  operator  would 
use  an  electrode  with  an  even  and  smooth  surface  (e.  g.  a 
ball-electrode).  Small  balls  and  points  favor  the  formation 
of  brushes  or  sprays  (breezes),  especially  if  the  end  of  the 
electrode  represents  an  aggregation  of  numerous  points, 
e  g.  the  crown-electrode,  which  is  used  to  administer  a 
head-breeze. 

THE  GROUND-WIRE. — An  iron  pipe  (water,  gas)  con- 
necting with  the  earth  can  be  used  for  a  ground-connection. 
The  side  of  the  machine  to  be  grounded  is  connected  with 
the  pipe  by  means  of  a  chain  or  wire  whenever  the  operator 
desires  to  make  a  ground-connection.  Some  physicians 
hook  a  chain  to  the  metal  portion  of  the  machine  on  the 
side  to  be  grounded  and  drop  the  end  of  the  chain  or  wire 
on  the  floor.  This  is  not  sufficient.  The  connection  mast 
be  made  with  the  earth  deep  enough  to  be  in  contact  with 
moist  ground.  The  object  of  grounding  is  to  increase  the 
potential  of  the  current.  In  some  applications  of  static  elec- 
tricity it  is  essential  for  correct  technique  to  ground  one  side 
of  the  machine,  e.  g.  in  giving  the  so-called  wave-current. 

THE  POLARITY  OF  THE  STATIC  CURRENT. — To  be  able 
to  tell  which  is  the  positive  and  which  is  the  negative  side 
of  the  machine  is  of  the  utmost  importance,  because  the 
whole  therapeutic  part  of  static  electricity  depends  upon  it. 
The  polarity  of  the  machine  must  be  tested  before  a  treat- 
ment is  given.  No  two  machines  are  alike.  Some  machines 
change  polarity  frequently.  There  are  several  ways  of  tell- 


208  MODERN  PHYSIO-THERAPY. 

ing  wnich  is  the  positive  and  which  the  negative  side  of  the 
machine : 

1.  Start  the  machine  slowly,  leaving  a  spark-gap  of  one 
inch.    The  first  spark  will  be  seen  to  travel  from  the  posi- 
tive to  the  negative  pole. 

2.  The  positive  end  of  a  one-inch  spark  has  a  white,  the 
negative  a  violet  color. 

3.  A  five-inch  spark  has  a  purple  positive  end  and  is 
bright  at  or  near  the  negative  pole. 

4.  The  "fox-tail"  discharge  is  on  the  positive  side.    The 
negative  end  of  the  spark  is  compact. 

5.  If  a  piece  of  wood  is  brought  near  the  positive  end 
of  the  spark,  the  spark  will  jump  over  to  the  wood.     The 
negative  side,  if  approached,  is  not  disturbed  in  the  least. 

6.  Ground  one  side  of  the  machine.     Start  the  machine 
with  the  sliding  rods  five  inches  apart.    If  there  is  no  spark, 
the  grounded  side  is  positive.    If  the  spark  is  more  vigorous 
and  thick  than  usual,  the  grounded  side  is  negative. 

7.  Look  at  the  discharging  combs  between  the  plates 
while  the  machine  is  running.    The  negative  side  will  show 
streams  of  purple  light,  the  positive  side  bright  points  on 
the  ends  of  the  comb-teeth. 

8.  If  a  burning  candle  is  held  between  the  terminals  of 
the  machine,  the  flame  will  point  toward  the  positive  side. 

9.  The  positive  side  attracts  dust  very  readily. 

The  most  valuable  point  is  probably  No.  7,  because  it 
enables  the  operator  to  see  the  polarity  while  the  patient  is 
being  treated. 

THE  POLE-CHANGER. — Many  static  machines  are  pro- 
vided with  a  device  for  changing  the  polarity  of  the  ma- 
chine. All  of  these  apparatus  (e.  g.  Cedergreen's  excellent 
device)  simply  reverse  the  currents  in  the  wires  carrying  the 
electric  energy  from  the  machine  to  the  patient  or  to  the 
X-ray  tube.  They  do  not  in  reality  change  the  polarity  of 
the  machine.  The  device  simply  causes  the  positive  current 
to  be  discharged  through  the  wire  on  the  opposite  side  and 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       209 

vice  versa.     In  X-ray  work  a  pole-changing  device  is  very 
serviceable. 

THE)  LEYDEN  JARS. — To  the  human  eye  a  static  spark 
seems  like  a  continuous  discharge.  In  reality  it  is  a  succes- 
sion of  discharges  which  follow  each  other  with  great 
rapidity.  Each  discharge  is  an  oscillation  of  electrified 
ethereal  molecules.  The  rapidity  with  which  these  oscilla- 
tions follow  each  other  constitutes  what  is  known  as  the 
"frequency"  of  the  current.  If  the  pressure  (electro-mo- 
tive force)  of  the  current  is  increased,  by  induction  for  in- 
stance, the  frequency  of  the  discharge  will  necessarily  be 
augmented.  This  is  the  purpose  of  the  so-called  Leyden 
jars,  one  of  which  is  placed  on  the  shelf  on  either  side  of  the 
machine.  It  consists  of  a  glass  jar  with  a  metallic  coating 
on  the  inside  and  the  outside,  the  coatings  (also  called  ar- 
matures) not  extending  to  more  than  one-third  of  the  height 
of  the  jar.  To  prevent  the  creeping  of  the  electric  charges 
over  the  glass  in  damp  weather,  the  glass  is  varnished.  The 
knob  on  top  of  the  jar  is  connected  with  the  inner  metallic 
coating  by  means  of  a  metallic  chain.  The  conductor  sup- 
porting the  knob  passes  through  a  dry  cork  or  plug  of  some 
insulating  material.  The  knob  on  top  connects  with  the 
metallic  parts  (prime  conductors)  of  the  machine  on  the 
positive  or  negative  side  respectively.  When  the  machine  is 
running,  the  inner  coatings  (armatures)  of  the  Leyden  jars 
receive  a  certain  charge  of  electricity.  By  induction  a  charge 
is  generated  in  the  outer  coating  (armature)  of  the  jar. 
The  outer  armature  is  supplied  with  a  binding-post  which 
may  be  situated  on  the  shelf  in  front  of  the  machine  and  is 
connected  with  the  outer  coating  of  the  jar  by  a  wire.  If 
a  conductor  (cord,  wire)  is  attached  to  this  binding  post, 
it  will  carry  the  current  which  has  been  induced  in  the  outer 
armature.  It  is  a  current  of  higher  voltage  nnd  greater 
frequency  than  the  primary  static  current.  It  is  known  as 
the  static  induced  current.  The  frequency  of  a  current  of 
this  kind  may  be  as  high  as,  and  even  higher  than  100,000.- 
ooo  oscillations  per  second.  Each  oscillation  is  a  wave  of 


210  MODERN  PHYSIO-THERAPY. 

ethereal  motion,  separated  from  the  preceding  and  succeed- 
ing oscillation  by  a  distinct  interruption.  The  greater  the 
number  of  interruptions,  the  greater  the  pressure  (electro- 
motive force).  The  coincident,  previously  discussed,  re- 
versal of  the  direction  of  pressure,  makes  each  oscillation 
equivalent  to  an  alternation.  The  two  terms,  therefore,  are 
in  this  sense  used  synonymously.  The  static-induced  cur- 
rent, then,  is  a  true  high-frequency  current. 

ELECTRODES. — An  instrument  by  means  of  which  elec- 
tricity is  administered  to  the  patient  is  called  an  electrode. 
A  set  of  suitable  electrodes  comes  with  each  static  machine. 
The  most  essential  electrodes  are, — i.  The  insulating  plat- 
form; 2.  The  large  crown  (breeze,  spray);  3.  The  small 
crown  (breeze,  spray)  ;  4.  A  ball-electrode  (sparks)  ;  5.  A 
wooden  electrode  (brush)  ;  6.  A  pointed  electrode  (brush, 
small  sparks).  In  addition  to  these  electrodes  there  ought 
to  be  an  insulated  hook  to  hold  chains  out  of  the  way  dur- 
ing a  treatment  and  prevent  unnecessary  sparking.  The 
ingenuity  of  individual  operators  has  suggested  different 
shapes  and  sizes  of  static  electrodes,  e.  g.  a  wire  cage  for 
spraying  the  whole  body.  The  massage-roller  is  used  by 
some.  The  cataphoric  electrode  is  worthless,  because  static 
cataphoresis  does  not  exist. 

In  giving  static  treatments  the  operator  should  not  be 
hampered  by  his  ignorance  of  static  technique,  or  by  his 
fear  of  electricity,  or  by  his  awkwardness  in  handling  the 
machine  and  the  patient.  The  constant  use  of  sparks  has 
justly  become  obsolete.  A  static  treatment  which  causes 
pain  is  of  doubtful  therapeutic  value.  In  a  general  way  it 
may  be  said  that  the  gentle  and  agreeable  modes  of  appli- 
cation answer  every  therapeutic  indication  of  static  elec- 
tricity. 

THE  MODES  OF  APPLICATION  ordinarily  recognized  as 
such  by  electro-therapeutists  are  as  follows : 

Insulation  (positive  or  negative). — Put  the  platform  in 
its  proper  position  about  two  feet  in  front  of  the  machine 
and  connect  the  sliding  rod  on  the  negative  side  with  the 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       211 

platform  by  means  of  a  rod  or  chain.  Ground  the  positive 
side.  This  gives  your  patient,  who  stands  or  is  seated  on 
the  platform,  a  negative  insulation.  If  the  positive  side  is 
connected  with  the  platform  and  the  negative  side  grounded, 
the  patient  gets  a  positive  insulation.  This  mode  of  static 
application  is  called  (positive  or  negative)  insulation,  elec- 
trification or  chargre. 


NEC. 

vy     w 


POSITIVE  INSULATION. 
AA  and  BB  represent  ground  wires. 

Direct  or  Primary  Spray  and  Breeze  (positive  or  nega- 
tive).— Connect  the  sliding  rod  on  the  positive  side  with 
the  platform  and  the  sliding  rod  on  the  negative  side  with 
the  crown  (multiple  point)  electrode,  the  rods  being  sepa- 
rated sufficiently  to  prevent  sparks  from  passing.  Hold  the 
electrode  at  a  suitable  distance  from  the  patient  to  allow  a 
stream  of  bluish  fire  (shower  of  fine  sparks)  to  pass.  This 


212 


MODERN  PHYSIO-THERAPY. 


A 


INDIRECT  NEGATIVE  SPRAY. 


INDIRECT  POSITIVE  (SMALL)  SPRAY. 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       213 

is  the  negative  direct  or  primary  spray.  If  the  electrode  is 
moved  away  until  only  a  current  of  electrified  air  is  drawn 
to  the  patient,  it  is  called  a  breeze.  A  breeze  is  a  mild  kind 
of  a  spray.  For  a  positive  direct  or  primary  spray  connect 
the  negative  side  of  the  machine  with  the  platform,  and  the 
positive  side  with  the  electrode.  If  a  ball  electrode  is  used 
the  result  will  be  the  passage  of  direct  or  primary  sparks. 


POS. 

w       \^/ 


V 

INDIRECT  POSITIVE  SPARK. 

Indirect  or  Secondary  Spray  and  Breeze  (positive  or 
negative). — Ground  the  positive  side  and  connect  the  nega- 
tive side  with  the  platform.  The  platform  and  the  patient 
are  charged  negatively.  By  induction  the  room  (walls, 
table,  etc.,  etc.)  is  charged  positively,  the  air  intervening 
between  patient  and  room  being  like  the  dielectric  (glass) 
of  a  Leyden  jar.  Place  a  metal  stand  on  the  floor  and  con- 
nect this  stand  with  the  earth.  By  connecting  the  small 
crown  (multiple  point)  electrode  with  the  stand,  the  elec- 


214  MODERN  PHYSIO-THERAPY. 

trode  will  be  charged  with  positive  electricity,  which,  with 
the  electrode  held  at  the  proper  distance  from  the  patient's 
body,  will  yield  a  positive  spray,  or,  if  moved  farther  away, 
a  breeze.  If  there  is  a  gas-fixture  in  the  room,  no  stand  is 
needed.  The  electrode  is  connected  directly  with  the  gas- 
fixture.  This  is  what  is  called  a  positive  indirect  or  sec- 
ondary spray  or  breeze.  To  give  a  negative  indirect  or  sec- 
ondary spray  or  breeze,  reverse  the  conditions.  If  instead 
of  a  crown  (multiple  point)  electrode,  a  ball  electrode  is 
used,  the  tendency  will  be  toward  the  formation  of  sparks 
instead  of  a  spray.  Sparks  thus  obtained  are  known  as  (posi- 
tive or  negative)  indirect  or  secondary  sparks.  The  poten- 
tial of  these  sparks  can  be  very  much  increased  if  the  Ley- 
den  jars  are  included  in  the  circuit,  their  outer  armatures 
being  connected  (short-circuited)  by  a  wire  or  rod  which 
passes  from  outer  coating  to  outer  coating.  In  this  way 
charges  of  high  potential  are  bound  by  the  inner  coatings 
(armatures),  the  charges  being  released  when  a  spark  passes 
between  electrode  and  patient.  The  same  holds  good  in  re- 
gard to  the  direct  or  primary  sparks. 

In  all  the  applications  named  there  is  an  air-space  be- 
tween patient  and  electrode  which  must  be  bridged  over 
before  the  circuit  is  completed.  In  this  respect  the  appli- 
cations named  differ  from  those  which  follow,  the  circuit 
in  the  latter  not  being  broken  between  electrode  and  patient, 
but  at  some  other  point  in  the  circuit. 

The  Static  Induced  Current. — Reference  to  this  current 
has  already  been  made.  The  Leyden  jars  are  in  the  circuit. 
The  cords  are  attached  to  the  binding  posts  connecting  with 
the  outer  armatures  of  the  Leyden  jars  and  the  patient  is 
placed  in  the  circuit.  The  platform  is  not  needed.  The 
electrodes  are  in  contact  with  the  patient's  body.  The  gap 
to  be  bridged  over  is  between  the  sliding  rods,  the  potential 
of  the  current  being  dependent  on  the  length  of  the  spark. 

Potential  Alternations  ( surging). — Make  all  the  con- 
nections for  a  positive  insulation,  adding,  however,  a  sep- 
arate stand,  which  is  grounded  and  placed  in  such  a  posi- 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       215 


THE  STATIC  INDUCED  CURRENT. 
Application  with  the  roller  is  shown. 


POTENTIAL  ALTERNATION  (MONELL,  MORTON). 


216 


MODERN  PHYSIO-THERAPY. 


tion  that  a  spark-gap  is  created  between  the  positive  slid- 
ing rod  and  a  horizontal  metal  bar  held  by  the  grounded 
stand.  The  sliding  rods  of  the  machine  are  separated.  The 
spark  passes  between  the  positive  sliding  rod  and  the  rod 


-v 

F 

—  — 

© 

s) 

H. 

FOOT 
PUTE 

PATIENT'S 

""CIRCUIT     "* 

5PONGE 
ELECTRODE 

INSULATED 

PLATTORM        E. 

POTENTIAL  ALTERNATION  (MODIFIED). 

A  is  a  wire  connecting  the  positive  side  (P)  with  the  foot-plate  (F). 
C  is  a  ground-wire  from  the  negative  side  of  the  machine  (Po  to  J).  D  is  a 
curved  insulated  rod  held  by  a  post  (I)  and  connected  (B)  with  a  wet  sponge- 
pad  (H),  which  is  applied  to  the  bare  skin.  G  is  a  spark-gap  which  is  closed 
or  opened  by  moving  the  sliding  rod  Po.  If  the  Leyden  jars  are  in  the  cir- 
cuit the  effect  is  more  marked.  It  can  be  still  more  enhanced  if  the  static  in- 
duced current  is  short-circuited  (connect  outer  armatures  S  and  So  by  closing 
switch  K).  By  alternately  opening  and  closing  spark-gap  G  a  surging  effect 
is  produced.  This  form  of  potential  alternation  i?  useful  in  rheumatism  and 
for  the  relief  of  pain  generally.  It  is  effective  in  muscular  and  nervous  weak- 
ness, sexual  neurasthenia,  dysmenorrhea,  etc.,  etc. 

held  by  the  grounded  stand.  Whenever  a  spark  passes  from 
the  positive  sliding  rod  to  the  earth,  the  patient  will  be 
traversed  by  an  oscillating  current.  The  arrangement 
spoken  of  was  first  used  by  S.  H.  Monell.  Morton  changed 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       217 


ir  by  substituting  a  spark-gap  electrode  to  be  held  by  the 
operator's  hand  for  the  arrangement  suggested  by  Monell. 
More  recent  modifications  are  shown  in  the  accompanying 
diagrams. 

The  Morton   Wave-current  is  named  after  Dr.  W.  J. 


POTENTIAL  ALTERNATION  (MODIFIED). 

The  static  induced  current  is  short-circuited,  not  by  closing  the  switch 
(C),  but  by  connecting  the  outer  armatures  (S  and  So)  with  a  solenoid,  the 
two  ends  of  which  are  connected  (A  and  B)  with  foot-plate  and  electrode. 
The  middle  third  of  the  solenoid  is  a  part  of  the  closed  static  induced  circuit. 
When  a  spark  passes  at  G  the  two  outer  thirds  of  the  solenoid  carry  shunt-cur- 
rents to  the  electrode  and  patient  respectively.  This  form  of  application  im- 
proves local  nutrition  and  has  marked  anodyne  properties. 

Morton,  of  New  York,  who  in  1899  gave  explicit  direc- 
tions concerning  this  application.  The  spark-gap  is  be- 
tween the  sliding-rods.  The  negative  side  is  grounded,  the 
positive  side  is  connected  with  the  platform  upon  which 
the  patient  is  sitting  or  standing,  the  strength  of  the  current 


218  MODERN  PHYSIO-THERAPY. 

is  controlled  by  the  spark-gap.  If  a  local  application  is  to 
be  made,  a  piece  of  block  tin  of  proper  size  is  firmly  placed 
on  the  skin  of  the  part  to  be  treated.  The  tin  is  connected 
with  the  positive  side  of  the  machine.  Several  pieces  of 
block 'tin  may  be  used  on  several  parts  of  the  body  at  the 
same  time.  Each  piece  must  be  directly  connected  with  the 
positive  side  of  the  machine. 

Since  everything  depends  on  the  proper  execution  of  the 
details  of  static  treatments,  it  behooves  the  operator  to  be- 
come proficient  in  the. technique  of  the  different  modes  of 
application  mentioned.  Nothing  equals  the  educational  ad- 
vantages of  self -treatment  for  experimental  purposes. 

High-Frequency  Apparatus. 

Reference  has  been  repeatedly  made  to  the  subject  of 
high-frequency  currents.  They  are  currents  characterised 
by  a  high  frequency  of  oscillations  (alternations).  Next  to 
the  constant  (galvanic)  current  it  is  the  currents  of  high 
frequency  that  are  of  superior  therapeutic  value  and,  there- 
fore, entitled  to  detailed  consideration. 

The  Question  of  Amperage. — In  order  to  understand 
some  of  the  remarkable  effects  produced  by  currents  of  high 
frequency,  it  is  necessary  to  think  of  some  of  the  elementary 
principles  of  electro-physics.  Owing  to  the  tremendous 
pressure  of  a  current  of  this  kind,  the  rate  at  which  the  cur- 
rent flows,  is  very  rapid.  One  coulomb  of  electricity  pass- 
ing through  a  conductor  in  one  second  is  called  an  ampere 
of  electricity.  If  the  pressure  is  great  enough  to  force  one 
coulomb  through  the  conductor  in  one-tenth  of  a  second, 
the  quantity  passing  in  one  second  would  be  10  amperes.  If 
one  coulomb  were  to  pass  in  the  hundredth  part  of  a  second, 
the  current-strength  would  be  100  amperes.  If  a  current  of 
this  kind  were  to  flow  in  one  direction  it  would  be  most 
dangerous  to  life.  These  currents,  however,  are  alternating 
and  the  alternations  are  so  rapid  that  the  sensory  nervous 
system  seems  to  be  unable  to  respond  to  them.  This  fact 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       219 

makes  these  currents  safe  to  use.    The  lower  the  frequency, 
the  more  dangerous  the  current. 

Phenomena  of  Induction. — The  wonderful  effects  pro- 
duced by  induction  in  secondary  conductors  will  be  better 
understood  by  a  careful  consideration  of  the  subject  of  in- 
duction which  has  been  discussed  in  connection  with  the 


OUDIN  RESONATOR. 

physics  of  the  faradic  induction-coil.  The  electro-motive 
force  in  the  secondary  coil  depends  on  the  number  of  turns 
in  the  primary  coil  and  on  the  frequency  of  the  interruptions 
of  the  current  in  the  primary  coil.  Every  interruption,  it 
will  be  remembered,  is  coincident  with  a  change  in  the  direc- 
tion of  the  current.  Let  us  suppose  that  an-  alternating  cur- 


220 


MODERN  PHYSIO-THERAPY. 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       221 

rent  of  two  amperes  and  a  frequency  of  1,000,000  is  cir- 
culating in  a  primary  wire  consisting  of  two  convolutions  of 
wire.  Let  us  place  a  solenoid  (a  cylindrical  coil  of  wire 
with  circular  convolutions)  in  the  magnetic  field  of  the 
primary  wire.  The  effect  on  this  solenoid  would  be  the  same 
as  if  200  amperes  were  circulating  in  a  primary  coil  of  200 
convolutions  with  a  frequency  of  100  alternations.  The 
effect  on  the  solenoid  depends  on  the  product  of  the  am- 
perage and  frequency  in  the  primary  wire.  In  this  way 
the  remarkable  effects  of  induction  of  high-frequency  cur- 
rents can  be  explained,  e.  g.  the  lighting  of  an  incandescent 
lamp  attached  to  a  wire  held  near  the  conductor  of  a  high- 
irequency  current. 

Resonance  Effects. — The  waves  of  electrified  ethereal 
molecules  which  emanate  from  a  current  of  high  frequency 
are  capable  of  causing  electric  oscillations  in  another  cir- 
cuit which  is  of  the  same  kind  or  has  a  direct  physical  rela- 
tion to  it.  The  second  circuit  responds  just  as  a  string  of 
proper  length  and  thickness  will  vibrate  in  sympathy  with 
some  other  string  which  has  been  set  in  motion.  The  phys- 
ical relation  between  these  two  strings  is  that  they  be  of 
the  same  length  and  thickness  or  that  the  length  and  thick- 
ness of  the  second  string  be  a  simple  fraction  or  a  multiple 
thereof.  Thus,  the  term  "resonance"  has  an  analogous 
meaning  in  electricity  and  is  borrowed  from  acoustics  to 
express  this  analogy.  The  high-frequency  instrument  which 
in  its  construction  is  based  on  this  phenomenon  of  "re- 
sonance," is  called  a  resonator. 

The  instrument,  device  or  apparatus  by  means  of  which 
high-frequency  currents  are  generated,  are  principally  the 
high-frequency  coil  of  D'Arsonval  and  the  resonator  of 
Oudin.  The  solenoids  which  can  be  attached  to  an  alter- 
nating light-circuit  or  the  diasolenic  cylinders  which  can 
be  attached  to  a  static  machine  are  very  useful  and  con- 
venient. The  Tesla  coil  as  a  therapeutic  instrument  is 
hardly  ever  used  at  present. 

The  High-Frequency  Coil  was  originated  by  D'Arson- 


222 


MODERN  PHYSIO-THERAPY. 


COIL  AND   DOUBLE  RESONATOR. 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       223 

val  and  is  available  in  conjunction  with  a  static  machine  or 
an  X-ray  coil.  It  consists  of  a  solenoid  which  is  in  the  cir- 
cuit of  the  outer  coatings  of  the  Leyden  jars.  Around  the 
solenoid  a  secondary  coil  is  placed  which  receives  the  cur- 
rent from, the  primary  coil  (solenoid)  by  induction.  The 
whole  arrangement  is  incased  in  a  box.  The  binding  posts 
on  top  connect  with  the  terminals  of  the  secondary  coil  while 
the  binding  posts  on  the  end  or  on  the  side  of  the  box  con- 
nect with  the  terminals  of  the  solenoid  which  in  this  way 
can  be  connected  with  the  outer  armatures  of  the  Leyden 
jars.  The  spark-gap  to  regulate  the  amount  of  current  is 
between  the  sliding  rods  of  the  static  machine.  If  an  X-ray 
coil  is  used  as  a  generator  of  the  current  a  condenser  is  in- 
terposed between  the  X-ray  coil  and  the  high-frequency  coil. 
The  condenser  plays  the  part  of  an  accumulator  analogous 
to  the  inner  armatures  of  the  Leyden  jars.  The  current 
from  a  D'Arsonval  high-frequency  coil  is  applied  by  means 
of  suitable  (glass,  metal,  condensing)  electrodes. 

The  Resonator,  originated  by  Oudin,  consists  of  a  sole- 
noid of  which  only  a  part  is  in  the  Leyden  jar  circuit,  the 
remaining  portion  receiving  its  electric  energy  by  resonance 
(see  above)  and  by  induction.  The  larger  the  portion  of  the 
solenoid  which  is  in  the  circuit,  the  greater  the  amount  of 
energy  and  the  higher  the  frequency.  The  electrodes  used 
are  glass,  metal  or  so-called  condensing  electrodes. 

The  Condensation  Conch  consists  of  a  sofa  or  lounge 
upon  which  the  patient  lies  down.  The  couch  is  connected 
with  one  terminal  of  a  solenoid  while  the  patient  is  con- 
nected with  the  other  terminal.  The  solenoid  is  in  the  cir- 
cuit circulating  between  the  outer  armatures  of  two  Leyden 
jars.  The  connection  between  solenoid  and  couch  is  by 
means  of  a  wire  which  is  attached  to  a  metal  plate  on  the 
couch.  The  connection  with  the  patient  may  be  made  by 
means  of  a  wire  and  metal  handle  held  by  the  patient.  The 
patient  lies  on  a  cushion,  beneath  which  the  metal  plate  is 
put.  The  constant  change  of  polarity  in  the  rapidly  oscil- 
lating discharges  of  the  Leyden  jars  causes  a  coincident 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       225 


VACUUM  ELECTRODES. 


hi. 


HIGH  TEXSIOX   ELECTRODES. 


226  MODERN*  PHYSIO-THERAPY. 

change  in  the  patient  and  the  lounge,  resulting  in  a  rapid 
and  continuous  back  and  forth  surging  of  high-frequency 
charges. 

The  Auto-conduction  Cage  is  a  solenoid  of  immense  size 
in  which  the  patient  stands.  The  solenoid  is  in  the  circuit  of 
two  Ley  den  jars,  the  patient's  body  constantly  receiving  in- 
duction-charges of  high  frequency. 

The  Diasolenic  Cylinder,  ("dia"  through,  "solen"  cylin- 
der,) suggested  by  the  author,  is  a  combination  of  the  prin- 
ciples of  condensation  and  auto-conduction.  The  cylinder  is 
an  immense  solenoid  which  is  connected  with  the  outer  ar- 
mature of  a  Leyden  jar.  The  platform  upon  which  the 
patient  lies  is  connected  with  the  outer  armature  of  the  other 
Leyden  jar.  The  spark-gap  is  between  the  sliding  rods  of  a 
static  machine.  A  rapid  change  of  polarity  takes  place  in 
the  platform,  in  the  cylinder  and  in  the  patient's  body. 
While  the  current  is  circulating,  charges  and  inductive  in- 
fluences of  high  frequency  and  potential  constantly  surge  to 
and  fro  in  the  patient's  body.  Some  operators  connect  cylin- 
der and  platform  with  one  side  of  the  machine  while  the 
other  side  is  grounded. 

The  high-frequency  electrodes  are  either  glass 
(vacuum),  metal  or  condensers.  Condensing  electrodes  are 
made  of  hollow  glass,  filled  with  pulverized  graphite  or  hav- 
ing an  inner  coating  of  tin-foil.  The  electric  charge  is  re- 
ceived and  condensed  by  the  inner  coating  or  graphite-pow- 
der and  an  induced  charge  is  produced  in  the  tissues  of  the 
patient  which  represent  the  outer  coating  (analogous  to  a 
Leyden  jar).  The  metal  electrodes  have  a  small  bulb  or  ball 
on  the  end  and  are  supplied  with  an  insulated  handle.  The 
vacuum-electrodes  consist  of  partially  exhausted  glass  tubes. 
the  color  of  the  light  in  the  tubes  depending  on  the  condi- 
tion of  the  vacuum.  These  electrodes  are  applied  to  the  skin 
directly.  A  very  useful  set  of  vacuum-electrodes  with  one 
universal  handle  has  been  devised  by  Dr.  W.  B.  Snow,  of 
New  York. 

So  much  for  the  physics  and  mechanics  of  medical  elec- 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       227 

tricity.  The  electro-therapeutic  achievements  of  the  past 
have  been  chiefly  along  the  line  of  galvanic  electricity.  The 
success  of  the  future  in  an  electro-therapeutic  direction 
promises  to  be  in  the  elaboration  of  the  wonderful  possi- 
bilities offered  by  currents  of  high  frequency. 


DIAGRAM  ILLUSTRATING  THE  MAGNETIC  FIELD. 


228  MODERN  PHYSIO-THERAPY. 


CHAPTER  IX. 

THERAPEUTIC   USES   OF   GALVANIC,  FARA- 

DIC,  STATIC  AND  HIGH-FREQUENCY 

CURRENTS. 

THE;  subject  of  medical  electricity,  more  especially  the 
part  of  the  subject  which  refers  to  the  action  of  electrical 
currents  on  animal  tissue,  has  been  encumbered  with  much 
unnecessary  detail,  theoretical  speculation  and  a  well-nigh 
endless  list  of  distinctions,  classifications  and  subdivisions. 
This  fact,  in  and  of  itself,  seems  to  be  sufficient  to  show  that 
the  professional  mind  is  by  no  means  clear  in  regard  to  the 
principles  of  electro-therapy.  The  subtle  and  undefined 
character  of  electrical  agencies  in  conjunction  with  the  mys- 
teries of  neuro-physiology  and  neuro-pathology  offers  a 
vast  territory  for  speculation  and  hypothetical  reasoning. 
Abstracting  from  that  which  is  purely  theoretical  and  of  in- 
terest to  the  laboratory-physiologist  rather  than  the  clini- 
cian, it  seems  reasonable  to  recognize  two  kinds  of  effects 
which  electrical  currents  might  be  able  to  produce  on  and  in 
the  animal -body. 

If  the  molecules  individually  and  collectively  are  dis- 
turbed in  their  position  and  relation,  if  their  nutrition  is  in- 
creased, diminished  or  altered,  if  function  is  stimulated  or 
depressed,  such  an  effect  might  be  attributed  to  a  physiolog- 
ical action.  This  would  be  a  generic  term,  covering  thermal, 
magnetic,  electrotonic,  physical,  somatic,  mechanical  and 
many  other  kinds  of  effects  referred  to  in  the  text-books. 
The  salient  point  is  that  these  effects  consist  in  modes  of  ac- 
tion that  are  strictly  in  accord  with  the  physiological  inten- 
tions expressed  in  the  activity  of  organic  matter.  There  is 


ELECTRO-PHYSICS  AND  ELECTRO-MECHANICS.       229 

no  impairment  of  structural  perfection.  The  molecule  is 
neither  physically  incapacitated  nor  chemically  disintegrated. 
In  keeping  with  these  facts,  the  salient  point  of  these  physio- 
logical effects  might  be  expressed  and  emphasized  by  desig- 
nating them  as  non-destructive.  They  affect  function  by 
altering  structure  within  physiological  limitations. 

Another  variety  of  effects  would  be  produced  by  the  ac- 
tion of  electrical  currents  on  structure,  altering  or  destroy- 
ing the  latter  by  disintegrating  its  chemical  constituents  or 
changing  the  proportion  of  the  latter.  These  effects  would 
be  chemical,  or  destructive  in  a  physiological  sense.  The 
electrolytic  action  of  a  galvano-puncture  would  be  a  chem- 
ical effect,  while  the  stimulation  of  the  vaso-  motors  by 
means  of  a  negative  static  application  would  be  distinctly 
a  physiological  effect. 

In  keeping  with  the  division  given  we  may  recognize 
physiological  and  chemical  effects  as  following  the  employ- 
ment of  the  galvanic  current. 

Physiological  Effects  of  the  Galvanic  Current. 
The  galvanic  current  seems  to  have  an  affinity  for 
nerve-structure.  The  individual  neurons  seem  to 
gratefully  respond  to  the  gentle  and  evenly  flow- 
ing stimulant.  In  the  order  of  their  response  to  a  mild 
galvanic  current  the  motor  nerves  seem  to  react  less 
promptly  than  the  sensory  nerves,  and  these  again  with  less 
precision  than  the  vaso-motor  (sympathetic,  trophic)  nerves. 
The  latter  show  the  deep  impression  which  even  a  compara- 
tively mild  galvanic  current  is  capable  of  producing,  by  the 
marked  changes  in  the  circulation  and  in  the  nutrition  of 
the  regions  treated.  The  electrical  tendency  is  toward  the 
negative  pole.  Thus,  there  is  an  over-stimulation  toward 
the  negative  pole  and  a  compensatory  tinder-stimulation 
at  the  positive  pole.  The  vessels  dilate  near  the  negative 
pole,  whereas  there  is  a  distinct  contraction  of  the  arteries  at 
the  positive  pole.  In  keeping  with  the  physiological  law 


230 


MODERN   PHYSIO-THERAPY. 


FARADISM    IN    RETROFLEXiOX. 


IXTRAUTERIXE  USE  OF  THE  BI-POLAR  ELECTRODE. 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        231 


FARADISM   IN  AXTEFLEXIOX. 


THE  BI-POLAR   ELECTRODE  IN   POSITION. 


232  MODERN  PHYSIO-THERAPY. 

\vhich  makes  function  dependent  on  nutrition  and,  therefore, 
on  circulation,  it  is  but  natural  to  see  increased  functional 
activity,  augmented  metabolism,  accelerated  oxidation,  in- 
tensified absorption  at  the  negative  side  and  the  opposite 
state  of  affairs  (sluggishness  of  functional  action)  at  the 
positive  pole.  The  decrease  in  the  amount  of  blood  at  the 
positive  side  lessens  blood-pressure.  This  fact  makes  the 
positive  pole  a  sedative  and  an  anodyne  of  great  value.  The 
increased  functional  activity  at  the  negative  pole  soon 
reaches  the  physiological  limit.  The  effects  of  overstimiila- 
tion  become  apparent.  The  skin  is  red  and  irritated,  the 
whole  region  hyperemic  and  on  the  verge  of  an  inflamma- 
tory action.  The  trophic  nerves  have  expended  their  force 
in  response  to  the  current.  The  physiological  effects  de- 
scribed explain  the  subjective  symptoms  which  accompany 
an  application  of  this  kind.  The  patient  experiences  a  sen- 
sation of  heat  or  burning  at  the  negative  side  while  the  posi- 
tive side  feels  numb. 

It  is  primarily  the  effect  of  a  mild  galvanic  current  on 
the  trophic  nerves,  and  through  these  on  the  blood-vessels 
and  lymphatics,  which  accounts  for  the  markedly  absorbent 
action  of  the  galvanic  current.  This  action  alone  is  fre- 
quently sufficient  to  account  for  the  disappearance  of  hyper- 
trophies, morbid  growths  and  effusions  after  galvanic  appli- 
cations. 

In  giving  galvanic  treatments  the  current  should  not  be 
abruptly  interrupted  unless  a  special  effect  is  desired.  Sub- 
jectively a  sudden  interruption  produces  an  exceedingly  dis- 
agreeable sensation,  especially  if  the  application  is  made  on 
or  near  the  head  or  chest.  A  sudden  interruption  of  the 
galvanic  current  acts  mechanically  on  the  muscular  tissue 
at  and  near  the  seat  of  application.  The  muscles  contract 
violently.  In  asthenic  and  atrophic  conditions  of  the  mus- 
cles and  in  paralytic  and  paretic  states  generally,  these  in- 
terruptions of  a  galvanic  current  are  very  effective,  espe- 
cially if  they  are  slowly  and  rhythmically  applied.  In  these 
coarse,  violent  applications  the  operator  can  be  guided  en- 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        233 

tirely  by  the  mechanical  effects  produced.  At  all  other 
times  it  is  advisable  to  follow  the  indications  of  the  milliam- 
peremeter. 

Mild  galvanization  (one  to  five  milliamperes)  of  a  spe- 
cial nerve  or  set  of  nerves  is  one  of  the  neatest  and  best 
electro-therapeutic  applications,  especially  if  the  operator  is 
dealing  with  a  clearly  diagnosed  condition  of  functional  im- 
pairment or  of  pain.  In  many  so-called  reflex  conditions  the 
galvanic  current  is  of  great  value.  Reflex  conditions  are 
always  due  to  a  lack  of  balance  on  the  part  of  portions  of 
the  nervous  system,  a  disturbance  of  co-ordination.  A 
nerve-impulse  may  travel  over  a  nerve-trunk  or  through  a 
series  of  neurons  simply  by  following  the  path  of  least  re- 
sistance. The  lack  of  resistance  is  a  functional  ailment  of 
some  special  nerve-structure.  A  functional  disorder  of  a 
nerve  is  always  an  indication  of  malnutrition,  usually  lack 
of  nutriment  or  the  wrong  kind  of  nutriment.  The  nerve, 
as  a  result,  is  functionally  below  par  and  possesses  less  than 
its  normal  resisting-power.  This  explains  the  causation  of 
reflex  neuroses,  of  neuralgias  and  many  obscure  nervous 
disorders. 

The  vomiting  of  pregnancy  is  a  classical  type  of  a  re- 
flex condition.  The  impulse  is  carried  by  fibers  of  the  solar 
plexus  in  response  to  impressions  received  by  some  of  the 
lower  abdominal  nerve-ganglia.  The  nerves  of  the  solar 
plexus  are  temporarily  ill-nourished  on  account  of  the 
physiological  hyperemia  in  and  near  the  internal  genitalia, 
and  in  this  way  these  nerve-fibers  present  the  path  of  least 
resistance.  In  these  cases  it  is  of  signal  service  to  compen- 
sate for  the  lack  of  nerve-energy  by  mild  galvanization  of 
the  vagus  and  phrenic  (side  of  neck  positive  pole,  epigas- 
trium negative  pole). 

In  facial  neuralgia,  in  fact  in  all  superficial  neuralgias, 
mild  galvanization  often  gives  prompt  relief.  The  positive 
pole  should  be  placed  on  or  near  the  aching  part.  The  nega- 
tive pole  should  be  put  on  some  point  in  the  continuity  of 


234  Moi.'KKX     I'HYSIO-THKRAPY. 

the  nerve  or,  if  practicable,  near  the  spinal  origin  of  the 
nerve. 

In  congestive  headaches  good  effects  are  produced  by 
placing  the  positive  (sponge)  electrode  on  the  forehead 
and  the  negative  (sponge)  on  the  back  of  the  neck  or  lower 
down,  at  the  same  time  making  firm  pressure  on  either  side 
of  the  occiput  and  back  of  the  neck.  A  mild  galvanic  cur- 
rent can  be  thus  applied  for  three  to  five  minutes.  To  in- 
sure good  electrical  contact,  sponge-electrodes  should  al- 
ways be  thoroughly  moistened. 

General  galvanization  by  means  of  a  mild  galvanic  cur- 
rent is  valuable  in  all  conditions  in  which  a  mild  tonic-stimu- 
lant is  indicated,  e.  g.  neurasthenia,  wasting  diseases,  con- 
valescence from  continued  fevers,  etc.,  etc.  The  negative 
electrode  is  placed  over  the  lumbar  vertebrae  and  slowly 
moved  upwards,  while  the  positive  electrode  is  slowly  car- 
ried over  the  whole  body-surface.  The  treatment  should  not 
last  longer  than  ten  minutes.  In  the  atonic  form  of  gastric 
and  intestinal  indigestion  mild  galvanization  of  the  abdom- 
inal contents  is  of  great  value.  In  all  these  applications  the 
operator  should  not  carry  the  treatment  to  the  point  of  irri- 
tation. It  is  plain  that  in  many  of  the  conditions  to  which 
mild  galvanization  is  applicable,  the  effect  can  be  enhanced 
by  the  discreet  addition  of  massage.  All  these  physiological 
effects  are  included  under  the  general  head  of  catalysis. 

Chemical  Effects  of  the  Galvanic  Current. 
When  the  point  of  irritation  has  been  reached  in  making 
an  application  of  a  galvanic  current,  certain  changes  occur 
in  the  tissues  and  fluids  of  the  body,  the  severity  of  these 
changes  depending  on  the  duration  of  the  application,  on  the 
amperage  of  the  current  used  and  on  the  pole  used.  The 
changes  may  consist  in  an  actual  destruction  wrought  by 
electro-chemical  decomposition  (electrolysis)  or  in  chemical 
alterations  due  to  the  introduction  of  chemical  agents  into 
the  tissues  and  fluids  of  the  body  (cataphoresis,  metallic 
electrolysis). 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        235 

POSITIVE;  (ANODAL)  ELECTROLYSIS. — This  designation 
comprises  certain  effects  which  occur  near  the  positive  pole 
of  a  galvanic  current  applied  to  the  tissues.  If  a  needle  is  in- 
serted into  a  piece  of  raw  meat  and  a  galvanic  current  of 
about  10  m.  a.  is  allowed  to  pass  with  the  needle  as  its  posi- 
tive pole,  the  needle  will  soon  be  found  to  stick  fast.  The 
point  of  insertion  will  look  dry,  white  and  shrunken.  If  the 
needle  is  made  of  iron,  steel,  copper  or  any  other  oxidizable 
material,  the  needle  will  be  oxidized  and  an  oxide  of  the 
metal  will  be  deposited  around  the  point  of  insertion  of  the 


ELECTRODES  FOR  POSITIVE  ELECTROLYSIS  IN  CAVITIES. 

No.  I  is  the  universal  holder.  Nos.  2,  3,  4,  5,  and  6  are  hard  rubber 
tips  which  fit  on  the  holder.  They  slip  over  the  copper  wire,  which  is  a  part 
of  the  holder,  and  are  introduced  into  the  cavity  where  treatment  is  to  be 
given.  The  cavity  is  filled  with  normal  salt  solution.  Tips  of  all  sizes  and 
shapes  are  made. 

needle,  causing  a  staining  of  the  tissues.  If  the  current  is 
strong  .enough,  the  stain  is  permanent.  The  positive 
pole  has  an  affinity  for  oxygen  and  for  acids.  The  lat- 
ter coagulate  the  tissue-albumen  and  in  this  way  interfere 
with  the  blood-circulation.  This  explains  the  styptic  action 
of  the  positive  pole.  After  the  application  has  been  made, 
the  current  is  turned  off  and  reversed.  In  this  way  the  elec- 
trode used  for  positive  electrolysis  is  released  and  can  be 
easily  removed. 

The   electro-chemical  destruction   of  tissue  makes  the 


236  MODERN  PHYSIO-THERAPY. 

positive  pole  available  in  the  treatment  of  various  conditions, 
to  wit : 

1.  Growths  consisting  of  dilated  capillaries  (angiomata, 
birth-marks,  cirsoid  aneurism,  varices,  acne  rosacea,  etc.). 
One  or  more  needles  representing  the  positive  pole  of  a  gal- 
vanic current  are  introduced  into  the  growth  until  the  coagu- 
lating and  styptic  effect  has  been  produced.     The  negative 
pole  is  put  in  an  indifferent  place. 

2.  Growths  of  soft  texture  (moles,  polypi,  fungi,  warts, 
etc.)  can  be  cured  by  cutting  off  the  blood-supply,  the  in- 
strument used  being  one  or  more  needles. 

3.  Hemorrhage,  active  or  passive,  especially  from  tur- 
gescent  mucous  membranes,  can  be  stopped  by  the  positive 
pole,  the  application  being  made  by  means  of  a  flat  electrode. 
This  application  is  available  in  gynecological  practice  to  stop 
bleeding  from  the  endometrium  (by  means  of  an  intra-uter- 
ine  electrode).   Infected  areas  (lupus,  tinea,  etc.)  are  often 
successfully  treated  by  positive  electrolysis.     It  is  well  to 
know  that  gonorrhea,  especially  in  the  post-acute  form,  can 
be  checked  by  positive  electrolysis.     The  gonococcus  can 
not  withstand  the  action  of  the  current  and  soon  becomes 
non-viable. 

NEGATIVE  (CATHODAL)  ELECTROLYSIS. — The  negative 
pole  of  a  galvanic  current  attracts  hydrogen  and  alkalies.  If 
a  needle,  charged  negatively,  is  thrust  into  raw  meat,  the 
needle  will  not  stick.  A  whitish  foam  will  issue  from  the 
point  of  insertion  of  the  needle,  the  foam  being  composed  of 
bubbles  of  hydrogen.  The  tissues  near  the  point  of  inser- 
tion are  softened  and  even  liquefied.  Therapeutically  the 
process  of  destruction  set  up  by  negative  galvanic  electricity 
can  be  utilized  in  the  treatment  of  manifold  conditions, 
to  wit : 

Superfluous  Hairs. — The  patient  holds  a  metal-handle 
electrode  in  his  hand.  The  other  electrode  is  a  fine  needle 
which  is  introduced  into  the  canal  from  which  the  hair 
emerges  and  the  current  is  turned  on,  the  needle-electrode 
being  charged  negatively,  the  handle-electrode  positively. 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        237 

The  object  is  to  destroy  the  matrix  of  the  hair-follicle.  As 
soon  as  a  little  whitish  foam  is  seen  to  issue  from  the  point 
of  insertion  of  the  needle,  the  current  is  turned  off  and  the 
needle  withdrawn.  The  hair  is  readily  taken  out  by  means 
of  a  suitable  forceps.  If  the  application  is  properly  made 
the  hair  will  not  grow  again. 

Cicatrices. — Scar-tissue  resulting  from  burns,  inflamma- 
tions or  various  traumatic  conditions,  can  be  softened  and 
stretched  by  negative  electrolysis.  In  cicatricial  strictures 
of  an  accessible  canal  this  method  is  indicated.  It  is  the 
ideal  way  of  handling  urethral  strictures  in  the  male.  Rob- 
ert Newman,  whose  name  will  for  all  time  to  come  be  asso- 
ciated with  this  branch  of  conservative  surgery,  gives  the 
following  directions  as  to  the  modus  operandi: 

The  urethral  electrode  to  be  used  should  consist  of  one 
piece.  The  tips  to  be  screwed  to  a  universal  handle  are  to 
be  condemned  because  they  are  likely  to  come  off  as  shown 
by  a  number  of  cases  of  this  kind.  Electrolysis  must  be  con- 
fined to  organic  strictures.  Spasmodic  strictures  are  likely 
to  be  aggravated  by  this  mode  of  treatment.  The  instru- 
ments should  be  clean.  In  lubricating  the  urethral  electrode 
of  proper  size  before  inserting  it,  remember  that  the  lubri 
cant  should  be  a  conductor.  Use  glycerine  or  white  of 
egg  5  avoid  oil  or  vaseline.  Let  the  patient  stand,  sit  or  lie 
down  according  to  his  sense  of  comfort.  Let  him  hold  the 
(positive)  handle-electrode  in  his  hand.  Introduce  the 
(negative)  urethral  electrode  until  it  is  arrested  by  the  first 
stricture.  Turn  on  the  current.  Guide  the  electrode,  never 
use  any  force  or  pressure.  The  electrolytic  action  will  soon 
enlarge  the  caliber  of  the  urethra,  enabling  the  instrument 
to  advance  slowly  and  pass  the  obstruction.  If  another 
stricture  exists,  proceed  in  precisely  the  same  manner. 
When  the  canal  is  clear  and  open,  turn  off  the  current  and 
withdraw  the  instrument.  Never  use  more  than  five  or  six 
milliamperes  of  current.  Watch  the  milliamperemeter  care- 
fully. Remember  that  electrolysis  is  a  species  of  absorption. 
It  means  neither  cautery,  nor  heat,  nor  dilatation,  nor  divul- 


238  MnnKKN     I'llYSIO-Tlll  KAPY. 

sion.  The  electrode  should  have  a  short  curve.  Begin  and 
end  the  operation  without  current,  i.  e.  turn  the  current  on 
and  off  after  the  instrument  has  been  introduced  and  before 
it  is  withdrawn.  The  operation  can  be  repeated  in  a  week. 
Never  use  more  than  one. instrument  during  one  treatment. 
Remember  that  electrolysis  will  cure  nearly  every  organic 
stricture  of  the  urethra.  Bad  results  are  always  attributable 
to  faulty  technique  or  mistaken  judgment.  Electrolysis  of  a 
urethral  stricture  should  be  bloodless,  painless  and  product- 
ive of  a  quick  and  good  result.  (Robert  Newman's  record 
is  a  list  of  more  than  2,500  cases  without  a  single  failure.) 
It  is  proper  to  add  that  negative  electrolysis  has  been  used 
to  great  advantage  in  cases  of  dysmenorrhea  caused  by 
stenosis  of  the  cervical  canal. 

Epithelial  Hypertrophies,  Warts,  Fungi,  Papillomata, 
etc. — If  a  (negatively  charged)  needle  is  used,  it  should  be 
inserted  on  a  level  of  the  skin  or  mucous  membrane,  the 
growth,  if  possible,  being  slightly  raised  by  means  of  a 
suitable  forceps.  The  growth  is  pierced  and  the  current 
turned  on.  When  electrolytic  action  is  complete,  the  current 
is  turned  off  and  the  needle  removed.  Another  insertion  at 
right  angles  to  the  first  is  made.  Sometimes  it  is  of  advan- 
tage to  use  two  or  more  needles  at  the  same  time  by  means 
of  a  suitable  needle-holder.  Different  shapes  of  electrodes 
are  often  serviceable.  On  general  principles  it  may  be  said 
that  negative  electrolysis  is  preferable  in  the  non-vascular 
variety  of  hypertrophies  and  growths  while  positive  elec- 
trolysis is  better  adapted  to  vascular  growths  where  the  cure 
is  accomplished  by  obliteration  of  the  vessels. 

Growths  of  the  Connective  Tissue  Type  (Fibromata, 
etc).  The  application  is  made  by  means  of  a  suitable  needle 
if  the  growth  is  easy  of  access,  otherwise  by  means  of  a  flat 
electrode  placed  on  the  skin  directly  over  the  growth.  The 
possibilities  of  this  method  in  cases  of  uterine  fibroids  (sub- 
serous,  intramural,  submucous,  more  especially  the  former 
two)  have  been  amply  demonstrated  by  Apostoli  and  his 
pupils.  The  usual  mode  of  application  consists  in  putting  a 


THERAPEUTIC  USES  o;~  VARIOUS  CURRENTS.        239 

(negative)  flat  abdominal  pad-electrode  directly  over  the 
growth  with  a  suitable  (positive)  electrode  in  the  vagina. 
Apostoli  inserted  a  (negative)  intra-uterine  electrode  and 
placed  a  (positive)  flat  electrode  on  the  abdomen.  He  em- 
ployed 50  to  250  milliamperes  of  current.  In  cases  of  easily 
accessible  growths  (submucous  fibroids,  polypi,  etc.)  he 
often  used  a  needle  or  trocar  charged  negatively.  The  treat- 
ments are  given  every  day  or  every  other  day  for  ten  to 
fifteen  minutes.  In  cases  of  goitre,  negative  electrolysis 
may  be  used,  two  sponge-electrodes  being  placed  on  the 
growth.  Sometimes  it  is  of  advantage  to  put  the  negative 
electrode  on  the  growth  and  the  positive  electrode  in  some 
indifferent  place.  The  needle  has  been  used  successfully, 
but  requires  considerable  technical  skill  and  experience  on 
the  part  of  the  operator. 

Bony  and  Cartilaginous  Grozi'ths. — Negative  electrolysis 
is  effective  in  removing  bony  outgrowths  in  the  nasal  fossa 
and  in  correcting  deviations  of  the  septum.  By  inserting  a 
(negative)  needle  of  suitable  size  into  the  substance  of  an 
accessible  osteoma,  exostosis,  enchondroma  or  enchondrosis 
anywhere  in  the  body,  disintegration  of  the  growth  can 
often  be  effected. 

METALLIC  ELECTROLYSIS  is  the  employment  of  an  elec- 
trode made  of  some  metallic  substance  capable  of  forming 
chemical  compounds  by  uniting  with  the  ions  at  the  positive 
or  negative  pole.  It  differs  from  cataphoresis  pure  and  sim- 
ple because  in  the  latter  chemical  substances  en  masse  are 
introduced  into  the  tissues  of  the  body,  whereas  in  metallic 
electrolysis  the  chemical  substance  is  formed  by  a  distinct 
chemical  process  which  is  set  up  by  the  use  of  a  suitable 
metallic  electrode.  Thus,  by  using  a  positive  electrode  made 
of  pure  copper  or  pure  zinc,  oxides  and  chlorides  of  copper 
and  zinc  are  formed  by  the  action  of  oxygen  and  chlorine  on 
the  copper  and  zinc  of  the  electrode.  This  therapeutic  use 
of  galvanism  has  been  elaborated  by  many  operators  re- 
cently, and  is  available  for  a  variety  of  clinical  purposes. 

An  interesting  form  of  metallic  electrolysis  is  the  use  of 


240  MODERN  PHYSIO-THERAPY. 

the  zinc-mercury  amalgam  electrode  at  the  positive  pole, 
championed  by  G.  Betton  Massey.  The  action  of  the  chem- 
ical products  (oxy chloride  of  zinc  and  mercury),  formed 
by  the  acid  ions  attacking  the  amalgam,  is  "sterilizing  and 
alterant  and  is  destructive  to  low  forms  of  tissue."  This 
mode  of  treatment  is  indicated  in  cases  of  local  sepsis  (ster- 
ilizing effect),  of  passive  congestions  (alterant  effect)  and 
in  cases  of  cancer  (destructive  action).  Gynecological 
practice  seems  to  offer  a  vast  field  of  usefulness  for  this 
method.  Metallic  electrolysis  as  well  as  simple  (positive 
and  negative)  electrolysis  are  much-neglected  branches  of 
conservative  or,  in  not  a  few  instances,  of  palliative  surgery. 
Many  an  inoperable  case  (e.  g.  osteo-sarcoma  of  the  upper 
jaw)  could  be  subjected  to  electrolysis  and  benefited.  The 
electric  current  is  in  these  cases  a  more  humane  and  a  more 
easily  managed  agent  than  the  knife. 

CATAPHORESIS. — The  introduction  of  chemical  agents 
(drugs)  into  the  body  by  means  of  an  electric  current  is 
called  cataphoresis.  The  only  current  available  for  this 
purpose  is  the  galvanic  current.  A  sponge-electrode  or  piece 
of  cotton  is  saturated  with  a  liquid  preparation  of  the  drug 
and  put  on  the  skin.  Very  convenient  cataphoric  electrodes 
have  been  placed  on  the  market  which  simplify  the  technique 
very  much.  The  operator  must  know  the  electric  affinity  of 
the  drug  he  is  using.  If  the  atoms  of  the  substance  he  is 
using  are  attracted  by  the  positive  or  negative  pole  of  the 
current,  the  substance  is  said  to  be  electro-positive  or  elec- 
tro-negative, as  the  case  may  be.  In  making  a  cataphoric 
application,  electro-positive  substances  must  be  used  with 
the  negative  pole  and  vice  versa.  Thus,  iodine  being  at- 
tracted by  the  positive  pole,  is  applied  by  means  of  the  nega- 
tive pole.  The  positive  pole  is  placed  at  some  distance.  The 
moment  the  current  is  turned  on,  the  atoms  of  iodine  will 
travel  toward  the  positive  pole  Cocaine  and  all  alkaloids 
are  attracted  by  the  negative  and  should,  therefore,  be  ap- 
plied under  the  positive  pole.  Iodide  of  potash  and  all  halo- 
gen salts  are  applied  under  the  negative  pole,  to  be  drawn 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        241 

toward  the  positive  pole.  For  local  anaesthesia  the  cata- 
phoric application  of  cocaine  deserves  to  be  better  known 
and  more  frequently  used  than  it  is,  especially  in  minor  and 
in  dental  surgery. 

ELECTRODES. — The  shape,  style,  size  and  general  con- 
struction of  the  electrodes  used  in  the  application  of  the 
various  modes  of  administering  galvanic  electricity  should 
be  prompted  by  the  purpose  to  which  the  electrodes  are  to 
be  adapted.  The  surface  to  be  treated  and  the  canal  or 
cavity  to  be  invaded  should  call  for  certain  shapes  and  sizes 
of  electrodes.  To  enumerate  them  would  be  an  endless  task. 
The  catalogues  issued  by  the  manufacturers  of  these  goods 
are  the  best  source  of  information.  The  principal  and  most 
important  feature  of  an  electrode  is  that  it  delivers  current 
to  the  body  without  offering  too  much  resistance.  The  elec- 
trical contact  between  electrode  and  skin  should  be  perfect. 
If  sponges  are  used,  they  should  be  wet.  Water  is  an  ex- 
cellent conductor.  For  this  reason  the  complete  or  partial 
bath  is  frequently  used  as  a  means  of  administering  elec- 
trical treatments.  The  region  to  be  treated  is  immersed  in 
the  water,  which  plays  the  part  of  the  electrode.  A  metal 
plate  in  the  water  is  connected  with  one  pole  of  the  bat- 
tery, the  other  pole  (e.  g.  sponge)  being  held  by  the  patient 
or  an  attendant,  who  applies  it  to  some  part  which  is  not  in 
contact  with  the  water.  The  technique  is  simple,  the  physio- 
logical action  being  in  accordance  with  the  principles  out- 
lined above.  The  immersion  in  medicated  water  is  a  splen- 
did mode  of  administering  cataphoresis.  On  general  prin- 
ciples direct  metal  contact  with  the  skin,  e.  g.  the  abdominal 
electrode,  is  not  desirable.  Contact  is  most  effective  and 
less  irritating  by  means  of  a  moist  sponge,  carbon,  or  by 
wet  cloth  wrapped  around  a  metal  electrode.  Electro-thera- 
peutic applications  that  are  painful  are  of  questionable 
utility  unless  pain  is  unavoidable.  If  pain  can  be  abided, 
it  .should  be.  Some  of  the  best  and  most  useful  electro- 
therapeutic  applications  are  painless  because  the  amperage 
used  is  slight.  Next  to  producing  a  good  therapeutic  result, 


242  MODERN  PHYSIO-TIIKKAI-Y. 

the  operator  should  strive  to  adopt  an  agreeable  mode  of 
procedure,  if  such  is  at  all  possible.  This  is  a  point  of  some 
importance,  because  much  of  the  pain  and  discomfort  inci- 
dental to  electro-therapeutic  procedures,  is  needlessly  in- 
flicted and  might  be  avoided  by  correct  technique.  Cleanli- 
ness is  a  necessary  part  of  electro-therapeutic  manipulations, 
especially  with  reference  to  the  electrodes  used.  To  use  wet 
sponge-electrodes  on  one  patient  after  another,  is  practically 
a  cataphoresis  of  dirt  and  as  such  has  no  place  in  the  arma- 
mentarium of  a  modern  electro-therapeutist. 

Faradism. 

Compared  to  the  therapeutic  importance  and  usefulness 
of  galvanic  electricity,  the  faradic  current  dwindles  into  in- 
significance. Its  therapeutic  uses  are  suggested  by  the 
markedly  excitant  and  stimulating  action  on  muscular  tissue. 
In  response  to  a  faradic  current  muscular  fibers  contract 
more  or  less  violently.  This  means  physiological  activity 
for  the  contracted  fibers  and  involves  increased  local  oxida- 
tion and  metabolism.  The  muscle-fiber  requires  more  blood 
after  exercise  of  this  kind  to  furnish  the  oxygen  required. 
In  this  way  more  nutriment  is  carried  to  the  muscle,  and 
the  latter  improves  both  in  functional  power  and  in  sub- 
stance. The  faradic  current,  therefore,  is  a  muscular  tonic 
within  physiological  limitations,  i.  e.  if  the  exercise  produced 
by  the  current  is  not  overdone  and  if  the  blood  drawn  to 
the  active  muscle  is  of  good  nutrient  quality.  The  exercise 
involved  in  faradic  contraction  of  muscle-tissue  must  not  be 
carried  to  the  point  of  fatigue  or  exhaustion  of  the  fibers. 
It  must  not  bruise  or  jar  them,  but  must  be  closely  in  imi- 
tation of  physiological  muscle-exercise.  Only  then  will  the 
distinctly  tonic  effect  of  the  faradic  current  become  manifest. 
Spasmodic  contractions  of  muscle,  e.  g.  cramps  in  the  ex- 
tremities or  the  spasmodic  form  of  dysmenorrhea,  are  al- 
ways due  to  some  perversion  of  the  functional  activity  of  the 
nerves  controlling  the  muscles  affected.  Since  functional 
nerve-diseases  per  se  do  not  exist  but  are  always  produced 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        243 

by  some  unidentified  change  in  the  structure  and  mutual 
relation  of  the  neurons,  and  are,  for  this  reason,  diseases  of 
local  nutrition,  it  is  plain  that  the  methodical  use  of  the  fara- 
dic  current  under  these  circumstances  has  a  logical  thera- 
peutic significance.  It  is  a  tonic  in  the  proper  sense  of  the 
word.  It  improves  the  tone  of  muscle  tissue  by  altering,  i.  e. 
t>y  improving  the  local  nutrition.  In  this  way  it  counteracts 
spasm  because  the  latter  is  due  to  a  lack  of  tone  of  the  mus- 
cle or  control  of  the  muscle-function  through  the  nerve- 
supply.  It  stands  to  reason  that  the  intensity  of  the  tonic 
effect  of  a  faradic  current  will  depend  on  the  extent  of  the 
area  treated  and  on  the  relative  adaptability  of  the  current 
to  take  the  place  of  physiological  exercise.  A  mild  faradic 
current  administered  to  a  patient  sitting  in  a  bath-tub,  the 
water  reaching  to  the  costal  border  (one  pole  in  the  water, 
the  other  applied  to  the  neck,  chest  and  back  by  means  of  a 
sponge-electrode),  ought  to — other  things  being  equal — 
produce  a  fine,  gentle  stimulating  effect.  There  must  be  no 
pain,  only  a  gentle  tingling.  Through  the  muscular  tissue 
the  current  is  bound  to  affect  contiguous  structures. 

The  faradic  current  is  useful  in  cases  of  redundant  pan- 
niculus  adiposus  in  the  abdominal  wall.  It  improves  the 
quality  of  the  muscular  tissue  of  the  abdominal  wall  at  the 
expense  of  the  fatty  layer.  It  stimulates  the  muscular  fibers 
in  the  walls  of  the  intestines  and  is,  therefore,  of  value  in 
the  treatment  of  atony  and  dilatation  of  the  stomach  and 
bowels.  In  rectocele,  cystocele,  prolapsus,  in  fact  in  all 
conditions  produced  and  aggravated  by  loss  of  muscular 
tone,  the  faradic  current  does  very  well.  It  enhances  the 
effect  of  massage  and  may  be  combined  with  massage  by 
causing  one  electrode  to  be  held  by  the  patient,  the  other  by 
the  unengaged  hand  of  the  operator.  This  is  a  splendid  ad- 
dition to  the  technique  of  Thure  Brandt  massage.  The  use 
of  the  rectal  electrode  is  of  great  benefit  in  the  treatment  of 
hysteria.  The  apparent  anodyne  action  of  a  faradic  cur- 
rent in  neuralgic  cases  (e.  g.  sciatica)  is  due  to  its  alterant 
action  on  the  muscular  tissue  and  through  the  latter  on  the 


244  MODERN  PHYSIO-THERAPY. 

circulation.  The  blood-supply  is  regenerated  and  the  cry 
of  the  nerve  for  healthy  blood  is  stilled.  The  use  of  violent 
faradic  shocks  is  never  indicated  except  in  paralytic  condi- 
tions where  it  is  a  question  of  making  an  impression  on 
tissue  that  has  hardly  any  vitality  left  in  it.  Painful  applica- 
tions of  the  faradic  current  are  never  proper. 

Owing  to  the  fact  that  the  faradic  current  is  an  alter- 
nating current,  it  is  of  little  consequence  which  pole  is  used. 
Polarity,  which  is  everything  in  galvanic  and  static  elec- 
tricity, is  of  no  consequence  in  faradic  applications.  For 
obvious  reasons,  the  faradic  current  can  not  be  used  for 
electrolysis  or  cataphoresis.  What  has  been  said  concern- 
ing the  electrodes  used  in  applications  of  the  galvanic  cur- 
rent, might  be  repeated  in  regard  to  faradic  applications. 
There  are,  however,  fewer  electrodes  required  because  the 
therapeutic  field  of  the  faradic  current  is  small  compared  to 
that  of  galvanic  electricity. 

Static  Electricity. 

"Static  electricity  is  adapted  to  the  scientific  treatment 
of  all  diseases," 

"Static  electricity,  if  administered  by  a  judicious  and 
skilled  operator,  is  a  valuable  adjunct  in  the  treatment  of 
many  chronic  diseases." 

"Static  electricity  is  a  suggestive  agent  of  no  inconsid- 
erable efficacy." 

These  three  statements,  quoted  from  three  different 
medical  text-books,  represent  the  three  camps  into  which 
the  profession  is  divided  on  the  subject  of  static  electricity. 
The  morbid  enthusiast  sprays  and  sparks  his  patients  for 
every  ill  to  which  human  flesh  is  heir.  The  skeptic  who 
knows  nothing  about  the  subject,  but  assumes  an  ex  cathedra 
tone  in  his  denunciation,  sees  nothing  but  the  suggestive  in- 
fluence of  ponderous  machinery  and  mysterious  perform- 
ance. Both  the  enthusiast  and  the  skeptic  are  at  fault.  The 
former  is  usually  deficient  in  his  knowledge  of  general 
medicine,  while  the  latter  is  positively  ignorant  about  the 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        245 

static  machine  and  its  legitimate  sphere  of  usefulness.  That 
this  sphere  of  usefulness  is  much  smaller  than  the  popular- 
ity of  the  subject  of  static  electricity  would  lead  us  to  be- 
lieve, is  unquestionably  a  fact.  Static  electricity  is  far  from 
being  a  panacea.  In  point  of  therapeutic  value  it  does  not 
rank  with  galvanic  electricity,  although  it  seems  to  be  supe- 
rior to  faradic  electricity.  Its  physiological  indications, 
however,  are  less  definite  than  those  of  either.  There  is  a 
larger  share  of  uncertainty  and  guesswork  in  the  applica- 
tion of  static  electricity  and  a  correspondingly  greater  por- 
tion of  the  suggestive  element  than  in  either  galvanism  or 
faradism.  Yet  static  electricity  possesses  certain  charac- 
teristic features  of  its  own  that  make  it  valuable  many 
times  and  actually  invaluable  sometimes.  Therefore,  the 
golden  mean  of  conservatism  expresses  a  fair  estimate  of 
the  subject.  There  is  no  doubt  that  static  electricity,  if  ad- 
ministered by  a  judicious  and  skilled  operator,  is  a  valuable 
adjunct  in  the  treatment  of  many  chronic  diseases. 

What  effect  has  static  electricity  on  living  organisms? 
The  life  of  man  is  spent  within  the  magnetic  field  of  the 
earth.  The  earth  is  a  magnet  rotating  around  its  axis  and 
surrounded  by  induced  positive  electricity,  the  earth  being 
the  negative  element.  The  particles  of  solid  matter  floating 
in  the  atmosphere  about  us,  the  moisture  and  vapor  that  fills 
space  in  many  degrees  of  density,  are  all  charged  positively. 
All  vegetation,  using  the  latter  word  in  its  vast  biological 
sense  and  including  the  animal  and  the  vegetable  kingdoms, 
is  a  phenomenon  dependent  on,  and  influenced  by,  positive 
electrical  charges.  The  researches  conducted  by  S.  Len- 
strom  at  the  physical  laboratory  of  the  University  of  Helsing- 
fors  and  by  expeditions  under  his  direction  in  different  parts 
of  the  world  and  under  varying  climatic  and  meteorological 
conditions,  have  demonstrated  the  influence  of  positive  elec- 
tricity on  vegetative  processes.  The  most  interesting  fea- 
ture of  his  experiments  is  the  fact  that  he  used  electricity 
produced  by  a  Holtz  machine  with  the  negative  side 


246  MODERN*  PHYSIO-THERAPY. 

grounded.  He  studied  the  effects  of  positive  charges  of 
varying  potential.  His  conclusions  give  to  positive  elec- 
tricity of  high  electro-motive  force  the  greatest  biological 
significance. 

There  is  no  doubt  whatever  that  animal  and  vegetable 
life  with  reference  to  the  relative  intensity  of  its  out- 
ward manifestations,  is  directly  influenced  by  the  difference 
in  potential  between  the  positive  and  negative  terrestrial  ele- 
ments. The  higher  the  potential  of  the  positive  element,  the 
more  active  the  processes  of  animal  and  vegetable  life. 
Lenstrom  showed  that  plants  grow  faster,  develop  better 
and  procreate  more  plentifully  under  continued  positive 
electrification.  Negative  charges  at  first  seem  to  have  a 
similar  effect.  Soon,  however,  the  activity  seems  to  lag. 
This  indicates  that  the  vital  energy  contained  in  the  organ- 
ism and  shown  in  its  growth  and  reproduction,  is  closely  re- 
lated to,  if  not  identical  with,  the  positive  element  which 
the  rapidly  revolving  earth-magnet  induces  within  its  mag- 
netic field.  Life  on  this  planet,  therefore,  is  electro-positive.1 

Translating  these  biologic  considerations  into  therapeutic 
language  it  would  seem  as  though  a  positive  insulation  (pa- 
tient on  the  platform  charged  positively,  negative  side 
grounded)  represents  an  arrangement  aiming  at  the  preser- 


1  It  is  not  improbable  that  phagocytosis  is  an  e'.ectro-magnetic 
process.  Animal  !ife  is  electro-positive.  Since  animal  life  depends 
on  the  action  of  oxygen  on  combustible  elements,  we  are  not  sur- 
prised that  oxygen  is  an  electro-positive  element.  It  has  an  affinity 
for  elements  which  are  foreign  to  the  organism  and,  therefore, 
negative,  e.  g.,  microscopic  scavengers.  The  latter  are  largely  anae- 
robic and  die  when  the  oxygen-carrying  corpuscular  elements  of  the 
blood  attack  them.  Considering  the  affinity  of  sunlight  for  oxygen 
we  are  prepared  to  understand  the  importance  of  sunlight  in  the 
treatment  'of  tuberculosis.  The  plasmodium  malariae  which  ema- 
nates from  the  earth,  is  eleciro-negative.  We  are  aware  that  the 
electro-magnetism  of  the  earth  is  subject  to  variation  as  the  result 
of  meteorologic  influences,  and  that,  therefore,  the  plasmodium 
must  necessarily  be  affected  by  the  variable  electro-magnetic  condi- 
tions of  its  habitat.  This  probably  accounts  for  the  variability 
(periodicity)  of  malarial  manifestations. 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        247 

vation  of  vitality  and  physical  energy.  Clinically  this  is  true. 
Wherever  and  whenever  a  tonic-sedative  is  indicated,  the 
positive  insulation  is  the  proper  static  application.  Positive 
static  electricity  tends  towards  structural  and  functional 
preservation  of  organic  tissue.  In  a  much  more  emphatic 
sense  this  statement  holds  good  when  the  potential  of  the 
positive  current  is  raised  by  induction,  e.  g.  by  the  use  of 
I,eyden  jars.  Thus  the  Morton  wave-current  may  be 
classed  as  an  agent  which  is  capable  of  increasing  the  physio- 
logical resisting  power  of  the  part  to  which  it  is  applied. 
It  restores  the  metabolic  equilibrium  which  is  disturbed  in 
all  conditions  characterized  by  increased  venous  and  de- 
creased arterial  pressure.  Passive  congestions  are  removed 
by  improving  the  physiological  "tone"  of  the  affected  re- 
gion. Pain  is  relieved  because  nutrition  is  rectified  and 
toxic  material  turned  into  the  proper  excretory  channels. 
Health  has  been  defined  "a  condition  characterized  by  per- 
fect equilibrium  of  arterial  and  venous  blood-pressure." 
Disturbance  of  this  equilibrium  results  in  locally  increased 
arterial  pressure  (hyperemia,  over-nutrition)  or  locally  aug- 
mented venous  pressure  (anemia,  under-nutrition),  both 
conditions  resulting  in  disturbed  nutrition  of  the  nerves 
whose  cry  for  proper  nutriment  we  call  pain.  Positive 
static  electricity,  especially  of  very  high  potential  in  restor- 
ing the  physiological  tone  of  the  affected  area,  tends  to  re- 
establish the  normal  equipoise  of  the  two  forms  of  pressure 
and  in  this  way  counteract  stasis  and  relieve  pain.  If  the 
physiological  tone  of  any  region  has  been  completely  sus- 
pended and  the  life-principle  is  fighting  for  preservation 
under  pathologic  conditions  (inflammation  or  its  antipode 
"a-trophy"  or  lack  of  nutrition),  positive  electricity  would 
be  of  no  avail.  All  positive  static  application,  including  the 
wave-current,  should  be  restricted  to  conditions  which  are 
characterized  by  lowered  tone  of  the  system  or  any  part, 
c.  g.  nervous  disorders,  venous  congestions,  chronic  in- 
flammatory conditions.  In  making  applications  of  this  kind, 


248  MODERN  PHYSIO-THERAPY. 

etiology  and  pathology  mean  everything.  Symptoms  have 
but  little  therapeutic  significance. 

It  is  of  some  importance  and  assuredly  of  considerable 
interest  to  know  something  about  the  physiological  modus 
operandi  in  which  static  electricity  acts  upon  the  tissues  of 
the  body.  Neiswanger  states  that  the  nerves  of  the  human 
system  are  like  tuning-forks  which  will  respond  to  a  certain 
number  and  strength  of  force-oscillations.  The  supposi- 
tion is  that  the  nervous  system  is  made  up  of  an  unlimited 
number  of  "receivers,"  each  one  being  capable  of  respond- 
ing to  a  certain  kind  of  a  vibratory  impulse.  The  author 
supposes  that  in  giving  a  patient  a  static  treatment,  one  or 
more  nerves  in  the  body  are  bound  to  vibrate  in  unison  with 
the  vibrating  force-modalities  that  are  reverberating  through 
the  system.  It  is  plain  that  the  explanation  is  neither 
physiologically  nor  therapeutically  admissible. 

The  human  body  as  a  conductor  of  static  electricity  does 
not  differ  from  other  conductors  in  the  manner  in  which  it 
receives  and  stores  this  kind  of  energy.  The  latter  accumu- 
lates on  the  surface  of  the  conductor.  It  is  the  skin  which  is 
the  real  conductor,  not  the  nerves  nor  any  other  structure  in 
the  body.  The  physiological  or  primary  effects  of  static 
electricity  are  confined  to  the  skin.  The  therapeutic  effects 
are  secondary  and  follow  in  physiological  sequence  the  ac- 
tion which  has  taken  place  in  the  skin.  The  part  which  the 
skin  plays  in  the  animal  economy  has  been  repeatedly  em- 
phasized, especially  under  the  head  of  HYDRO-THERAPY. 

Analogous  to  the  atmospheric  pressure  which  regulates 
the  intra-vascular  blood-pressure,  the  functional  energy  of 
nerve-tissue  is  regulated  by  the  terrestrial  magnetic  field  by 
which  we  are  surrounded.  Diminution  of  air-pressure 
causes  dilatation  of  the  vessels  along  the  external  and  in- 
ternal surface  of  the  body.  This  accounts  for  the  occurrence 
of  hemorrhages,  especially  from  the  exposed  mucosae,  when 
atmospheric  pressure  is  decreased.  When  the  potential  of 
the  positive  magnetic  energy  is  lessened,  it  diminishes  the 
degree  of  active  control  which  the  nerves,  the  carriers  of 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        249 

life-energy,  exercise  over  the  several  parts  of  the  or~anlsrn. 
Thus  the  muscular  fibers  in  the  blood-vessel  walls  are  re- 
laxed and  the  vessel  itself  dilates,  the  moment  the  mag- 
netic or  electrical  tone  of  the  vaso-motors  is  lessened.  This 
occurs  through  the  cutaneous  nerves  which  are  alone  ex- 
posed to  influences  of  a  magnetic  character.  The  skin- 
nerves  receive  the  impetus,  the  vaso-motors  show  its  physio- 
logical presence.  This  explanation  is  analogous  to  the 
physiological  syllogism  by  which  Winternitz  explains  the 
action  of  thermic  stimuli.  If  the  patient  receives  a  negative 
t.pray,  the  positive  potential  of  the  region  is  lessened,  nerve- 
tension  decreases,  the  tissues  relax  and  the  arteries  dilate. 
\\'e  look  upon  negative  applications  of  static  electricity  as 
being  stimulating  in  character  because  the  arteries  dilate 
and  the  amount  of  arterial  blood  increases.  The  more  the 
positive  potential  of  the  body  decreases,  the  more  stimulat- 
ing will  be  the  effect  of  a  negative  static  current.  The 
stimulating  effect  will  finally  merge  into  an  irritating  action 
2S  seen  by  the  redness  and  soreness  of  the  skin  which  fre- 
quently follows  negative  local  applications.  If  the  poten- 
tial of  the  body  is  increased,  the  electrical  action  will  be  re- 
storative, tonic,  sedative.  If  applied  to  the  head,  the  posi- 
tive current  will  cause  cerebral  anemia  and  somnolence ;  the 
negative  current  will  stimulate,  causing  wakefulness  and 
mental  activity. 

The  skin  is  undoubtedly  the  scene  of  action  of  static 
currents.  Through  the  skin  the  whole  system  is  reached,  a 
sedative  or  a  stimulating  effect  being  reflected  through  the 
sympathetic  nervous  system  as  well  as  by  contiguity  of  tis- 
sue. Thus  we  may  produce  a  distinctly  physiological  ef- 
fect on  the  renal  circulation  by  applying  a  wave-current  to 
the  small  of  the  back  in  cases  of  chronic  interstitial  nephritis. 
That  the  static  current  is  of  the  greatest  value  in  disorders 
of  the  skin  itself,  goes  v/ithout  saying. 

A  characteristic  effect  of  static  electricity  is  its  action  on 
oxygen.  Oxygen  has  an  affinity  for  positive  electricity. 
When  a  positive  charge  of  static  electricity  passes  through  a 


250  MODERN  PHYSIO-THERAPY. 

volume  of  oxygen,  a  disintegration  of  the  gas  and  a  rear- 
rangement of  atoms  of  oxygen  take  place.  A  new  gas  is 
formed  which  has  negative  affinity  and  is  tri-atomic.  It  is 
called  ozone  and  has  a  characteristic  odor.  The  passage  of 
a  flash  of  lightning  through  the  atmosphere  likewise  pro- 
duces ozone  (tri-atomic  oxygen).  Ozone  has  more  power- 
ful oxidizing  properties  than  oxygen.  When  a  positive 
static  spray  is  administered  to  the  skin,  some  of  the  oxygen 
in  the  tissues  and  in  the  cutaneous  vessels  is  changed  to 
ozone  and  circulates  as  such,  giving  to  the  body,  but  more 
especially  to  the  exhaled  air,  the  characteristic  smell  of 
ozone. 

From  what  has  been  said  concerning  the  physiological 
effects  of  static  electricity,  we  are  prepared  to  summarize 
the  therapeutic  indications  of  the  several  static  currents  as 
follows : 

1.  Positive   static   electricity   is   to   be   administered   to 
counteract  hyperemia,  nervous  irritability,  pain  due  to  con- 
gestion,  exaggerated   reflexes,   and   all   conditions   due   to 
overstimulation.     It  is  a  gentle  circulatory  regulator,  nerv- 
ous sedative  and  analgesic. 

2.  Negative  static  electricity  is  to  be  administered  to 
counteract  sluggishness  of  the  circulation,  lack  of  nerve- 
response,  pain  due  to  venous  stasis   (ischemia),  absent  or 
retarded  reflexes  and  all  conditions  requiring  stimulation. 
It  is  a  decided  stimulant,  excitant  and  even  irritant. 

The  different  methods  of  applying  static  electricity  are 
partly  a  matter  of  preference  on  the  part  of  the  operator, 
partly  suggested  by  the  character  of  the  case.  For  general 
treatments  the  insulation  and  the  use  of  the  head-breeze  are 
the  best  modes  of  application.  For  local  troubles  the  most 
useful  methods  are  the  direct  and  indirect  spray,  potential 
alternation  and  the  Morton  wave-current.  The  operator 
should  endeavor  to  make  a  static  treatment  as  agreeable  and 
comfortable  to  the  patient  as  possible.  There  should  be  no 
unnecessary  sparking  and  shocking.  Hats,  combs  and  steel- 
corsets  should  be  removed. 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        251 

There  is  always  a  suggestive  element  in  using  static 
electricity.  This  is  a  fact  which  is  too  well  estab- 
lished to  be  questioned.  Let  the  operator  direct  the  sug- 
gestive influence  into  the  proper  channel  in  the  interests  of 
the  patient.  Let  the  operator's  efforts  not  be  confined  to 
this.  He  should  look  upon  the  suggestive  effect  as  being  in- 
cidental and  secondary  to  a  well-planned  and  well-adapted 
therapeutic  method  based  on  clearly  defined  diagnostic  fea- 
tures of  the  case  and  on  exact  knowledge  of  the  physiolog- 
ical indications  and  possibilities  of  static  electricity. 

Currents  of  High  Frequency. 

Next  to  galvanism  the  so-called  high-frequency  currents 
are  the  most  interesting  and  promising  agents  along  electro- 
therapeutic  lines.  Properly  speaking,  it  is  not  in  keeping 
with  the  present  state  of  our  knowledge  to  classify  these 
agents  under  the  head  of  electro-therapy  except  in  a  pro- 
visional sense.  From  a  physical  standpoint  the  classification 
is  not  open  to  objection.  In  a  physiological  sense,  however, 
its  correctness  is  not  altogether  well  established.  The  currents 
of  high  frequency  produce  effects  on  the  organism  that  have 
nothing  in  common  with  the  physiological  activities  of  gal- 
vanism, faradism  or  static  electricity.  The  physiological 
effects  of  high  frequency  suggest  the  action  of  force-modali- 
ties that  are  properly  included  under  the  head  of  radiology. 
The  mysterious  rays  of  Roentgen  and  the  ultra-violet  rays 
of  Finsen  seem  to  bear  a  closer  relationship  to  these  cur- 
rents of  high  frequency  than  do  the  forms  of  electricity  here- 
tofore discussed.  It  seems  that  we  are  at  the  border-line 
where  electrical  modalities  merge  into  the  force-manifes- 
tations of  visible  and  invisible  light-rays.  It  appears  diffi- 
cult to  identify  the  currents  of  high  frequency  as  electrical 
phenomena  when  we  consider  their  remarkable  conduct  un- 
der given  physiological  conditions.  On  the  other  hand, 
they  are  so  closely  related  to  currents  of  high  voltage  or 
static  machine  currents  that  it  seems  illogical  to  separate 
them  from  force-modalities  so  closely  related  to  them.  It 


252  MODERN  PHYSIO-THERAPY. 

is  undoubtedly  a  fact  that  they  are  the  link  between  elec- 
tricity and  light,  borrowing  from  either  some  characteristic 
physical  properties  and  promising,  therefore,  to  occupy  a 
therapeutic  place  some  day  to  which  neither  electricity  nor 
light  can  aspire. 

The  first  form  of  a  high-frequency  current  that  received 
attention  and  study  from  a  therapeutic  point  of  view  was 
the  static  induced  current  with  which  the  name  of  Morton 
will  always  be  associated.  The  physics  of  high  frequency 
was  elaborated  by  D'Arsonval  and  Tesla,  principally  by  the 
former,  to  whom  we  are  also  indebted  for  much  of  our 
knowledge  concerning  the  physiological  aspect  of  the  sub- 
ject. It  was  he  and  his  colleagues  Apostoli  and  Oudin  who 
did  the  pioneer  work  in  this  new  and  wonderful  field. 

The  term  "high  frequency"  is  a  relative  one  and  refers 
to  the  excessively  high  speed  of  alternations  of  the  current. 
The  term  "alternation"  suggests  the  conduct  of  the  electro- 
motive force,  the  direction  of  which  is  varying  or  alter- 
nates. In  conjunction  with  the  medium  through  which  the 
electrical  force-manifestations  occur,  namely  the  ether,  the 
alternations  are  coincident  with  movements  of  the  electrified 
ethereal  molecules.  These  movements  are  oscillatory  in 
character.  For  this  reason,  the  term  "oscillation"  as  the 
physical  characteristic  of  currents  of  high  frequency  is 
used  synonymously  with  "alternation."  Strictly  speaking, 
the  two  terms  are  not  synonymous.  All  force-manifesta- 
tions depend  on  oscillatory  movements  of  the  ethereal  mole- 
cules. The  phenomena  of  non-alternating  (direct)  elec- 
trical currents  are  likewise  oscillatory, — so  are  all  evidences 
of  force-modalities.  The  very  character  of  an  alternation 
suggests  a  complex  process  of  ethereal  movement,  consist- 
ing of  at  least  two  oscillations  of  each  molecule  giving  to 
each  wave  (undulation)  a  distinct  progressive  movement 
serially,  and  transverse  movement  molecularly.  Thus  the 
ether  is  traversed  by  impulses  of  varying  intensity,  fre- 
quency and  direction.  In  this  way  many  lines  of  force- 
direction  and  vibration  are  established  which  belong  to 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        253 

other  force-modalities,  or  rather  which  are  the  physical 
characteristics  of  the  latter.  Thus  under  given  favorable 
conditions  the  complex  process  of  vibration  set  up  by  a  cur- 
rent of  a  certain  high  frequency  may  present  the  vibratory 
character  (speed,  wave-length)  of  the  X-rays  and  many 
other  force-modalities  belonging  under  the  head  of  ultra- 
violet force-manifestations.  The  friction  and  collision  of 
the  individual  rapidly  moving  molecules  are  again  a  fruit- 
ful source  of  force-production  and  account  for  the  wonder- 
ful induction-phenomena  which  are  characteristic  of  cur- 
rents of  high  frequency.  We  are  prepared  to  admit  that  the 
currents  of  high  frequency  represent  a  complex  force- 
modality,  or  rather  a  variable  combination  of  force-modali- 
ties. They  are  neither  all  light  nor  all  electricity,  but  con- 
tain the  potentialities  of  many  varieties  of  visible  and  in- 
visible light,  of  X-rays,  of  electricity  and  perhaps  of  other 
modalities,  the  knowledge  of  which  is  still  hidden  in  the 
bosom  of  the  future. 

The  therapeutic  importance  of  high  frequency  is  con- 
tained in  the  close  relationship  between  currents  of  high 
frequency  and  the  rays  emanating  from  the  ultra-violet 
field  or  fields  of  the  spectrum.  This  relationship  has  been 
independently  suggested  by  different  observers.  In  1902 
the  author  became  suspicious  of  this  relationship  when  two 
of  his  assistants  suffered  from  subacute  conjunctivitis  which 
they  contracted  from  exposure  to  the  Finsen-rays.  Shortly 
afterwards  an  attendant  developed  a  subacute  conjunctivitis 
who  had  not  been  exposed  to  the  ultra-violet  radiations  of 
the  Finsen  arc-lights.  This  attendant  had  worked  with 
static  and  high-frequency  electricity  exclusively.  The  au- 
thor was  unable  to  account  for  the  eye-affliction  of  the 
nurse,  when  it  occurred  to  him  that  the  light  from  the 
vacuum-electrodes  might  have  produced  it.  There  was  no 
doubt  about  the  other  two  cases  being  cases  of  ultra-violet 
conjunctivitis  such  as  are  frequently  seen  in  persons  who 
work  by  electric  arc-light.  In  thinking  over  the  etiology 
of  the  third  eye-case,  the  possibility  of  chemical  rays  being 


254  MODERN  PHYSIO-THERAPY. 

mixed  with  the  high-frequency  discharge  suggested  itself. 
The  silicate-of-zinc  test  was  resorted  to.  The  silicate  of 
zinc  did  not  show  the  characteristic  greenish  fluorescence. 
The  test  was  a  dismal  failure.  Next  sensitive  photographic 
plates  were  resorted  to,  to  ascertain  the  presence  of  chem- 
ical light.  A  number  of  these  plates  showed  no  effect  after 
development,  others  did.  One  5x7  plate  was  black  after 
development.  The  results  of  these  tests  were  suggestive 
enough,  and  were  communicated  to  an  authority  in  the  East 
with  a  request  for  an  opinion.  His  opinion  was  that  the 
effect  on  the  plates  was  due  to  rays  of  daylight  which  had 
not  been  excluded,  that  the  experiments,  while  very  inter- 
esting, were,  deficient  in  technique,  and,  therefore,  value- 
less. He  gave  it  as  his  opinion  that  there  was  no  connec- 
tion between  high-frequency  currents  and  chemical  rays. 

Since  the  experiments  were  made,  that  which  was  a 
casual  suspicion  at  that  time,  has  become  the  basis  of  the 
therapy  of  high-frequency  currents.  Observations  leading 
to  the  establishment  of  this  basis  were  independently  made 
by  many  observers  in  all  parts  of  the  world  as  far  back  as 
1900.  The  incongruity  of  the  opinions  was  the  outcome  of 
the  endless  number  of  degrees  of  frequency  which  are  in- 
cluded under  the  general  head  of  ''high"  frequency.  The  fre- 
quency of  the  current  determines  the  coincident  oscillatory 
and  undulatory  phenomena.  A  current  of  a  certain  frequency 
may  cause  coincident  ultra-violet  undulations,  while  another 
current  of  a  different  frequency  might  produce  no  such  inci- 
dental results.  Yet  both  currents  might  belong  under  the 
general  or  rather  under  the  generic  head  of  high-frequency 
currents.  This  point  was  foreshadowed  by  Bloch,  of  Paris, 
who  commented  on  the  uncertain  therapeutic  character  of 
high-frequency  currents  in  the  treatment  of  eczema,  and 
attributed  the  variability  of  the  therapeutic  effect  to  the 
variability  of  the  frequency  of  the  current.  He  suggested 
that  a  better  knowledge  of  the  frequency  of  these  currents 
would  be  essential  for  the  establishment  of  therapeutic  prin- 
ciples. He,  of  course,  thought  of  high-frequency  currents 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        255 

as  electrical  agents  pure  and  simple.  He  did  not  suspect 
that  these  currents  might  be  classed  as  radiologic  potencies. 

The  therapeutic  effects  of  currents  of  high  frequency  are 
both  electrical  and  radiologic.  A  current  of  comparatively 
low  frequency  (500,000  oscillations  or  less  per  second) 
produces  percussion-effects  analogous  to  static  currents. 
The  cutaneous  nerves  respond  and  are  principally  concerned 
in  the  physiological  reaction  which  follows.  The  effect  is 
in  the  nature  of  an  over-stimulation  which  results  in  hy- 
peremia  and  subsequent  over-nutrition  of  the  surface 
treated.  If  the  application  is  continued  the  reaction  will 
gradually  become  more  violent,  resulting  in  a  dermatitis. 
Currents  of  this  kind  are  produced  by  the  high-frequency 
coil  which  is  attached  to  the  static  machine.  If  the  vacuum 
electrode  is  held  at  a  slight  distance  from  the  skin,  the 
sparks  which  pass  between  the  skin  and  the  glass  resemble 
static  sparks  in  their  intensely  irritating  local  action. 

A  comparatively  high  frequency  (500,000  and  1,000,000 
or  more  oscillations  per  second)  does  not  produce  electrical 
effects  of  such  a  well-marked  character.  The  stream  of 
sparks  is  supplanted  by  the  effluve-effect.  For  this  kind  of 
work  the  Oudin  resonator  is  well  adapted.  The  physiolog- 
ical action  on  the  skin  is  analogous  to,  and  not  infrequently 
identical  with,  that  of  concentrated  actinic  light,  even  to 
the  extent  of  the  characteristic  erythema  and  pigmentation. 
It  is  these  true  currents  of  high  frequency  that  contain  in 
their  manifestations  the  ultra-violet  element.  It  is  safe  to 
say  that  the  therapeutic  uses  of  these  currents  are  largely 
dependent  upon  the  chemical  rays  which  are  contained  in 
the  latter. 

The  electro-motive  force  in  both  low-  and  high-fre- 
quency currents  is  very  intense. '  Thus  we  obtain  in  all  high- 
frequency  applications  the  effects  of  high  voltage,  especially 
the  disorganizing  action  on  the  oxygen  in  the  tissues  and  in 
the  red  blood-corpuscles.  Whether  these  currents  pene- 
trate into  the  interior  of  the  body  or  whether  their  electrical 
and  physiological  activity  is  confined  to  the  surface  of  the 


256  MODERN  PHYSIO-TIIKRAPY. 

body,  is  not  altogether  clear,  although  it  seems  probable 
that  their  penetrating  power,  if  at  all  present,  is  analogous 
to  that  of  the  radiations  from  an  excited  X-ray  tube.  The 
muscular  contractions  which  currents  of  high  frequency  are 
capable  of  causing  are  amply  accounted  for  if  we  look  upon 
them  as  being  due  to  the  activity  of  the  sympathetic  nerves 
and  not  due  to  any  direct  penetrating  action  of  the  electric 
energy.  The  presence  of  heat-rays  in  the  radiations  from 
a  high-frequency  generator  is  easily  demonstrated 

In  justice  to  the  subject,  it  may  be  of  interest  to  know 
what  opinions  have  been  advanced  by  individual  observers 
concerning  the  physiological  effects  of  currents  of  high 
frequency. 

D'Arsonval  considers  the  distinction  between  high  and 
less  high  frequency  of  the  greatest  practical  moment.  He 
states  that  the  sensory  nerves  can  not  be  stimulated  except 
within  certain  extremes  of  relative  frequency.  Below  and 
above  these  extremes  they  will  not  respond.  He  says  that 
cellular  life  is  stimulated  by  high-frequency  currents  in  the 
same  sense  in  which  an  increase  in  the  positive  potential  of 
the  organism  will  stimulate  vegetative  function.  Through 
the  cellular  elements  metabolism  is  increased.  The  excre- 
tion of  C  O2  is  50  p.  c.  more  active,  the  output  of  urea  is 
augmented,  the  excretion  of  uric  acid  diminished.  Func- 
tions of  the  stomach  and  intestines  become  more  active. 
D'Arsonval  made  his  observations  on  patients  who  had  been 
placed  in  his  high-frequency  cage. 

Hoorweg  thinks  that  the  physiological  action  of  high- 
frequency  currents  consists  of  resonance-effects  within  the 
organism.  Apostoli  demonstrated  an  increase  in  the  quan- 
tity of  the  urine  and  urea  and  an  increase  in  the  oxyhemo- 
globin  of  the  blood.  Patients  are  able  to  stand  more  ex- 
ertion. They  digest  better  and  sleep  more  soundly.  Tripet 
found  that  high-frequency  currents  (general  applications) 
caused  the  quantity  of  sugar  in  diabetic  urine  to  be  mark- 
edly diminished.  Freund  states  that  the  quality  of  the 
blood  is  improved  in  every  way  and  attributes  this  effect 


THERAPEUTIC  USES  OF  VARIOUS  CURRENTS.        257 

lo  the  ozone  which  is  formed  in  the  body  and  carried  by  the 
red  blood-cells.  In  diseases  of  the  blood  and  blood-making- 
apparatus  and  in  tuberculosis  the  high-frequency  current  is 
an  agent  of  supreme  value.  The  increase  in  the  oxygen- 
appropriating  power  of  the  organism  is  well  marked. 

The  effects  of  high-frequency  currents  on  bacterial  life 
have  been  studied  by  many  observers.  The  consensus  of 
opinion  is  that  germs  are  killed  and  their  toxines  modified 
and  rendered  innocuous  by  high-frequency  currents.  The 
latter  modify  the  poison  of  scorpions  and  serpents,  and  ren- 
der it  harmless.  D'Arsonval  succeeded  in  suspending  the 
vitality  of  diphtheria-cultures  by  short  exposures  to  high- 
frequency  currents.  Algae  and  fungi  are  permanently  de- 
vitalized by  these  currents.  Certain  animals,  especially 
rodents  and  the  smaller  felines,  are  susceptible  to  high-fre- 
quency currents  and  are  easily  killed  without  any  apparent 
pain  or  struggle. 

Therapeutically  the  currents  of  high  frequency  repre- 
;ent  the  most  valuable  agent  in  the  treatment  of  skin-dis- 
eases, excelling  any  and  all  agents  in  this  particular  de- 
partment of  clinical  medicine.  They  are  indicated  in  all 
cases  of  mal-nutrition  of  the  skin,  especially  the  dry  form 
of  eczema,  in  fact  all  disorders  of  the  cuticle  requiring 
stimulation  of  the  circulation  and  of  the  functional  activity 
of  the  skin.  They  render  good  service  in  cases  of  lupus 
erythematosus,  psoriasis,  tinea,  acne,  etc.  The  application 
is  made  by  means  of  a  vacuum-electrode.  Reaction  is  in 
proportion  to  the  distance  between  glass  and  skin. 

In  cases  of  general  diseases  in  which  the  quantity  and 
quality  of  the  blood  are  below  par,  general  applications  by 
means  of  an  auto-conduction  cage,  a  condensation-couch  or 
a  diasolenic  cylinder  are  indicated.  This  holds  good  with 
special  significance  in  cases  of  consumption.  In  honor  of 
the  distinguished  professor  of  physiology  at  the  University 
of  Pans,  who  did  so  much  in  the  interest  of  scientific  elec- 
tro-therapy, especially  along  the  lines  of  high-frequency 


258  MoDKKN     PlIVSIO-TlILRAPY. 

currents,  this  general  application  has  been  called  "D'Arson- 
valization." 

The  high-frequency  currents  are  indicated  in  cases 
where  metabolism,  especially  the  excretion  of  waste  through 
the  kidneys,  is  at  fault.  Even  locally  these  currents  alter 
and  improve  tissue-change,  which  makes  them  particularly 
valuable  in  cases  of  rheumatism  and  neuralgia. 

The  greatest  accomplishments  in  this  promising  and  in- 


THE   D'ARSOXVAL   COIL. 

teresting  department  of  clinical  medicine  are  yet  to  come. 
As  soon  as  the  exact  relationship  of  the  ultra-violet'  radia- 
tions, the  X-rays  and  the  currents  of  high  frequency  has 
been  identified,  there  will  be  unfolded  unto  our  eyes  a  vista 
of  untold  clinical  possibilities.  More  light  to  guide  our 
faltering  footsteps  along  the  hidden  paths  that  wind 
through  this  mysterious  land  of  wonderful  promises,  is  the 
consummation  devoutly  to  be  w:sh?d. 


X-R.\v  DIAGXOSIS.  259 


CHAPTER  X. 
X-RAY  DIAGNOSIS.1 

(The  Roentgcn-tubc. — The  Fluoroscope. — The   Principles 
and  Practice  of  Radiography.) 

THE  success  of  radiographic  as  well  as  radio-therapeutic 
work  hinges  upon  an  accurate  knowledge  of,  and  skill  in, 
the  use  of  the  vacuum-tube  (X-ray  tube,  Crookes  tube) 
by  which  the  Roentgen  rays  are  produced.  Familiarity  with 
the  tube  is  the  indispensable  condition  of  successful  X-ray 
work.  Without  a  good  and  suitable  tube  it  is  impossible  to 
do  good  work.  The  tube  is  by  far  the  most  important  part 
of  any  X-ray  equipment. 

The  Roentgen  Tube. 

The  tubes  which  are  generally  used  nowadays  are  varia- 
tions of  the  same  original  type :  a  glass  globe  with  a  num- 
ber of  tubular  projections  communicating  with  its  interior. 
The  positive  terminal  (anode)  is  in  the  center  of  the  globe 
and  is  represented  by  a  platinum  disc.  The  negative  termi- 
nal (cathode)  is  a  concave  (cup-shaped)  circular  piece  of 
aluminium,  from  which  the  so-called  cathodal  rays  emanate 
and  meet  in  a  point  on  the  anodal  disc  called  the  anodal 
focus.  This  point  is  plainly  visible  in  tubes  which  have 


1  The  contents  of  the  chapters  on  X-RAY  DIAGNOSIS  and  X-RAY 
THERAPY  have,  in  substance,  been  published  by  the  author  in  the 
"Journal  of  Advanced  Therapeutics,"  the  "Journal  of  the  Roentgen 
Society  (London,  England),"  the  "Archives  of  Physiological 
Therapy,"  the  "Journal  of  Progressive  Therapeutics,"  'rtc.  The 
diagrams  are  original  with  the  ant!:cr. 


260 


MODERN  PHYSIO-THERAPY. 


been  used,  either  as  a  small  discolored  spot  or  by  actual  loss 
of  substance  at  the  focal  point.  The  anode  is  frequently 
called  "anti-cathode"  on  account  of  its  position. 

The  exhaustion  of  an  X-ray  tube  is  done  by  the  tube- 
maker  while  a  powerful  current  from  the  secondary  wind- 
ing of  a  large  induction-coil  passes  through  it.  When  the 

a 


DIAGRAM  OF  AN  X-RAY  TUBE. 

G,  positive  attachment.  K,  negative  attachment.  J,  anode  of  the 
regulating  attachment.  E,  cathode  of  the  regulating  attachment. 
A,  connection  between  tube  and  regulating  device. 

exhaustion  has  been  carried  to  the  desired  point,  the  tube  is 
closed.  If  the  degree  of  exhaustion  is  relatively  perfect, 
the  tube  is  called  a  hard  tube,  while  a  comparatively  low  de- 
gree of  exhaustion  produces  what  is  known  as  a  soft  tube. 
Thus  the  relative  hardness  or  softness  of  a  tube  depends  on 
the  degree  of  exhaustion  or  the  vacuum.  When  the  tube  is 
properly  lighted  up,  the  connections  being  properly  made, 
the  hemisphere  in  front  of  the  anodal  disc  is  aglow  with  a 
characteristic  greenish  light  while  the  hemisphere  back  of 
the  anode  remains  practically  dark.  The  plane  which  sep- 
arates the  two  hemispheres  is  known  as  the  anodal  plane. 


X-RAY  DIAGNOSIS.  261 

The  X-rays  are  produced  on  the  outside  of  the  tube  and 
represent  lines  which,  if  they  were  continued  toward  the 
interior  of  the  tube,  would  all  meet  in  the  anodal  focus.  The 
latter,  then,  is  the  true  center  of  radiation.  When  a  tube 
has  been  used  a  great  deal,  the  glass  in  front  of  the  anode 
gradually  takes  on  a  bluish  hue.  This  is  due  to  the  deposit 
on  the  internal  surface  of  the  tube  of  fine  particles  of  plati- 
num and  is  always  a  sign  of  age.  Owing  to  the  fact  that 
these  particles  of  platinum  have  a  tendency  to  absorb  gas  or 
air,  an  old  tube  is  most  likely  to  be  a  hard  tube.  All  these 
points  referring  to  the  physics  of  the  tube  itself  and  the 
physical  characteristics  of  the  rays  emanating  from  the  tube 
will  be  fully  discussed  under  special  heads. 

The  spark-length  of  a  tube  is  the  length  of  the  electric 
spark  between  the  terminals  of  a  static  machine  or  a  coil 
which,  with  the  tube  in  the  circuit,  would  cause  the  tube  to 
functionate  properly.  The  vacuum  of  the  tube  determines 
the  required  spark-length.  Thus,  if  a  tube  of  a  certain 
vacuum  is  lighted  up  properly  by  electric  energy  capable  of 
producing  a  five-inch  spark,  the  tube  is  supposed  to  have  a 
spark-length  of  five  inches.  The  form  of  electricity  which 
is  capable  of  lighting  up  an  X-ray  tube  is  characterized  by 
high  voltage  and  low  amperage.  For  this  reason  the  static 
machine  is  available  for  X-ray  work.  Static  electricity  has 
but  little  volume  but  tremendous  electro-motive  force.  In 
the  X-ray  coil  the  ordinary  street-current  is  transformed 
into  one  of  high  voltage  by  the  action  of  the  so-called  in- 
terrupter and  by  the  induction  which  takes  place  in  the 
secondary  winding  of  the  coil.  The  original  type  of  the 
X-ray  induction  coil  is  the  Ruhmkorff  coil,  the  construction 
and  physics  of  which  are  analogous  to  the  faradic  coil. 

The  relative  usefulness  of  an  X-ray  tube  consists  in  its 
degree  of  exhaustion  (vacuuwC]  and  in  its  fitness  to  retain 
its  vacuum  for  a  reasonable  length  of  time.  The  vacuum  is 
changeable  in  all  tubes.  Even  during  one  X-ray  exposure 
the  internal  conditions  of  the  tube  gradually  become  differ- 
ent. The  passage  of  the  electric  currents  sets  free  mole- 


262 


MODERN  PHYSIO-THERAPY. 


cules  of  gas  or  air  that  have  been  absorbed  by  particles  of 
platinum.  The  constant  tendency  of  a  tube  to  change  its 
vacuum  makes  it  desirable  to  have  some  means  of  controll- 
ing the  vacuity  of  a  tube.  This  is  the  object  of  the  so- 
called  regulating  device  or  attachment  for  softening  or 
hardening  the  tube.  The  regulating  device  contains  two 
terminals  (a  glass  peg  with  a  platinum  spiral  for  the  posi- 
tive side,  a  disc  for  the  negative  side).  The  negative  ter- 


A  GOOD  STATIC  X-RAY  TUBE  WITH  REGULATING  DEVICE. 

minal  of  the  regulating  attachment  is  connected  with  a 
movable  wire  which  can  be  brought  near  or  in  contact  with 
the  negative  (cathodal)  attachment  of  the  tube  itself,  i.  c. 
the  hook  or  eye  for  attaching  the  negative  cord  to  the  tube. 
If  the  movable  piece  of  wire  on  the  negative  side  of  the 
regulating  attachment  is  brought  close  enough  to  the 
cathodal  end  of  the  tube  itself  to  allow  a  spark  to  pass  from 
the  cathodal  end  of  the  tube  to  the  wire,  the  spark  will 
travel  along  the  wire  and  be  communicated  to  the  disc 


X-R.\Y  DIAGNOSIS. 


A  HEAVY  ANODE  X-RAY  TUBE  WITH  REGULATING  DEVICE. 


A  WATER-COOLED  X-RAY  TURE  WITH  REGULATING  DEVICE. 


264 


MODERN  PHYSIO-THERAPY. 


which  represents  the  negative  terminal  in  the  regulating  at- 
tachment. The  disc  is  made  out  of  some  chemical  mixture 
which  has  the  property  of  setting  gas  free  when  an  electric 
current  passes  through  it.  The  gas  passes  into  the  interior 
of  the  X-ray  tube  and  loivers  the  vacuum,  rendering  the 
tube  softer.  If  the  movable  piece  of  wire  is  turned  up  and 
and  the  negative  cord  is  attached  directly  to  the  eye  in  the 
wire  (near  the  upper  end  of  the  wire)  the  softening  effect 
would  be  correspondingly  prompter  and  more  intense,  be- 
cause all  of  the  negative  current  would  pass  through  the 


DIAGRAM  ILLUSTRATING  THE  PRINCIPLE 
OF  THE  SPARK-GAP. 

chemical  disc.  If  the  negative  cathodal  cord  is  left  undis- 
turbed and,  instead,  the  positive  (anodal)  cord  is  detached 
from  the  tube  and  attached  to  the  positive  end  of  the  regu- 
lating device,  the  positive  current  would  pass  into  the  plati- 
num spiral  around  the  glass  peg.  The  platinum  spiral 
would  eventually  become  hot  and  gradually  absorb  gas  from 
the  interior  of  the  tube,  thus  rendering  the  vacuum  liighcr 
and  the  tube  itself  harder.  It  is  well  to  know  that  it  takes 
a  good  deal  longer  to  harden  a  tube  than  to  soften  it.  If 
the  tube,  while  in  action,  does  not  show  the  two  hemispheres 
(green  and  dark)  and  is  filled  with  a  bluish  light,  it  is  too 
soft  for  the  production  of  X-rays.  In  cases  of  this  kind  a 
spark-gap  on  the  cathodal  side  will  often  make  the  tube 


X-RAY  DIAGNOSIS.  265 

available  (see  diagram).  If  a  stream  of  blue  light  or  a  spark 
passes  between  anode  and  cathode,  the  tube  is  worthless  for 
X-ray  work,  because  too  much  gas  or  air  is  present  in  the 
tube,  indicating  a  puncture.  The  same  may  be  said  when 
the  anode  is  surrounded  by  an  areola  of  reddish  light.  The 
tube,  under  these  conditions,  must  be  re-exhausted.  Tubes 
that  have  become  too  hard  may  be  temporarily  restored  by 
prolonged  rest  or  by  slowly  heating  them  in  a  dry-heat 
cylinder  (oven). 

These  are  the  salient  points  in  regard  to  all  X-ray  tubes. 
The  geometrical,  physical,  chemical  and  physiological  prob- 
lems involved  in  the  handling  of  the  tube  and  in  the  applica- 
tion of  its  force-modalities,  we  will  have  occasion  to  con- 
sider at  some  length  under  the  special  heads  of  RADIOGRAPHY 
and  RADIO-THERAPY. 

The  Roentgen  rays,  for  purposes  of  diagnosis  may  be 
Used  in  two  ways, —  (i)  with  the  aid  of  the  so-called  fluoro- 
scope,  and  (2)  as  a  means  of  affecting  a  photographic  sensi- 
tive plate  upon  which  the  shadows  of  an  object  are  recorded. 

Fluoroscopy. 

The  fluoroscope  is  a  screen  made  of  pasteboard  upon 
which  a  layer  of  some  chemical  mixture  is  placed,  which  be- 
comes fluorescent  when  acted  upon  by  X-rays.  The  screen 
is  usually  incased  in  a  quadrilateral  pyramidal  box,  which 
is  supplied  with  a  handle,  the  screen  representing  the  base  of 
the  pyramidal  box,  the  apex  of  the  pyramid  being  open. 
The  fluoroscope  is  held  by  the  hand  of  the  operator,  with 
the  screen  nearest  the  object.  The  most  common  fluorescent 
substances  used  in  making  fluoroscopes  are  calcium  tung- 
state  and  barium  cyanide. 

The  fluoroscope  enables  the  operator  to  get  a  direct 
image  of  many  parts  of  the  body,  the  shadow-picture  being 
projected,  on  the  screen.  Fluoroscopy  requires  a  softer  tube 
than  skiagraphy.  Differentiation  of  the  shadows  of  an  ob- 
ject is  more  essential  when  the  human  retina  receives  the 
picture  than  when  a  sensitive  plate  is  acted  upon.  Fluoro- 


266  MOHKKX  PnYsio-Tin  KAPV. 

scopy  should  be  practiced  in  a  dark  room,  and  not  until  the 
eyes  of  the  operator  have  become  habituated  to  the  absence 
of  day-  or  artificial  light  (ten  to  fifteen  minutes).  The  less 
the  eye  of  the  operator  is  irritated  by  actinic  light  the 
greater  will  be  its  discriminating  power  in  regard  to  the 
shadows  of  an  X-ray  ima^e  thrown  on  a  fluoroscopic  screen. 
In  order  to  prolong  the  life  of  a  fluoroscope  as  much  as  pos- 
sible, the  instrument  should  be  kept  in  a  dry  dark  place  and 
protected  against  dust.  The  common  size  of  a  fluoroscope 
is  6x8  inches.  For  examinations  of  large  parts  (e.  g. 
the  chest)  a  fluoroscope  of  appropriate  size  should  be  em- 
ployed. 

In  a  general  way  it  may  be  stated  that  the  value  of  the 
fluoroscope  has  been  and  is  very  much  overrated.  Its  use- 
fulness is  restricted  to  comparatively  superficial  parts 
(hand,  wrist,  elbow,  thin  shoulder,  foot,  small  knee,  child's 
hip,  neck  and  chest).  Examination  of  an  adult's  hip  by 
means  of  a  fluoroscope  is  never  satisfactory.  Fluoroscopic 
examinations  of  the  abdomen  of  adults  are  impossible,  the 
statements  of  optimistic  radiographers  notwithstanding. 
The  operator  should  guard  against  the  suggestive  influences 
of  his  own  imagination,  lest  he  see  things,  not  because  they 
are  actually  there,  but  because  he  expects  to  see  them  and 
wants  to  see  them.  The  operator  who  seriously  stated  that 
the  diagnosis  of  gall-stones  can  be  made  by  means  of  a 
fluoroscopic  examination,  and  that  he  could  make  out  the 
pancreas  and  other  viscera,  was.  certainly  laboring  under  a 
powerful  auto-suggestion.  Even  in  superficial  parts  every- 
thing depends  on  the  experienced  eye  of  the  operator.  It 
may  be  safely  said  that  the  fluoroscope  has  a  fourfold  pur- 
pose and  should  be  used  accordingly : 

1 .  To  ascertain  the  presence  of  a  foreign  body ; 

2.  To  study  a  fracture  or  a  dislocation ; 

3.  To  study  parts  which  are  necessarily  movable  (intra- 
thoracic  contents)  and,  therefore,  do  not  make  good  sub- 
jects for  skiagraphic  work ; 

4.  To  make  an  examination  of  a  part  which  is  to  be  skia- 
graphed.    To  explain : 


X-RAY  DIAGNOSIS.  267 

It  is  understood  that  the  fluoroscope  can  not  be  used  on 
parts  of  the  body  that  do  not  project  distinctly  differentiated 
shadows  on  the  screen.  If  the  tube  is  too  low,  the  shadow 
of  a  hand  would  be  a  jet-black  silhouette.  Such  a  shadow 
picture  would  be  worthless  in  locating  a  foreign  body.  If 
the  tube  is  too  hard,  the  shadows  of  the  bones  would  be  too 
faint  and  not  distinct  enough  to  show  the  details  of  a  frac- 
ture. It  is  essential,  therefore,  to  use  the  proper  kind  of  a 
vacuum.  If  the  part  to  be  examined  is  too  dense,  e.  g.  the 
abdomen,  it  is  useless  to  attempt  fluoroscopy.  The  chest 
offers  a  fairly  good  field  for  fluoroscopic  examination.  'The 
movements  of  the  diaphragm  and  the  heart,  the  size  and 
position  of  the  heart,  the  presence  of  mediastinal  tumors, 
calcareous  deposits  and  foreign  bodies  in  the  lungs  can  be 
seen  and  closely  observed.  The  fluoroscope  serves  a  splen- 
did purpose  in  giving  the  operator  a  view  of  many  parts  of 
the  body  before  he  takes  a  skiagraph.  Fluoroscopy  should 
precede  skiagraphy,  whenever  this  is  practicable.  In  the 
hands  of  an  unskilled  operator  the  fluoroscope  has  often 
proved  to  be  productive  of  harm  rather  than  good,  because 
it  offers  a  constant  and  strong  temptation  to  permit  imagina- 
tion to  take  the  place  of  judgment.  The  ideal  way  of  mak- 
ing an  X-ray  diagnosis  is  to  allow  the  rays  to  project  the 
shadow-picture  on  a  sensitive  plate. 

Radiography. 

(N.  B. — "Radiography"  is  the  term  generally  employed  by  the 
profession.  While  it  is  etymologically  objectionable,  it  is  preferable 
to  "skiagraphy."  which  practically  means  the  art  of  making  shadow- 
pictures  ("skia,"  shadow},  irrespective  of  the  agent  _which  is  em- 
ployed. Both  terms  cover  the  ground  not  only  of  X-ray  photogra- 
phy, but  include  all  radio-active  substances  and  agents.  In  accord- 
ance with  the  scientific  tendency  of  classifying  physical  phenomena 
in  keeping  with  the  causes  which  produce  them,  radiography  seems 
to  be  the  better  term  because  it  refers  to  the  cause,  while  the  term 
"skiagraphy"  suggests  the  effect  produced.) 

There  seems  to  be  no  doubt  that  the  method  of  taking 
X-ray  pictures  is  to  a  large  extent  the  result  of  habit  and 


268  MODERN  PHYSIO-THERAPY. 

convenience  and  is,  therefore,  with  most  operators  an  en- 
tirely personal  problem.  It  is  true  that  there  are  certain 
vague  notions  of  fundamental  principles  which  serve  as  a 
ground  work  for  skiagraphic  procedures  generally.  In 
point  of  detail,  however,  and  with  reference  to  the  conscious 
adaptation  of  radiographic  work  to  specific  anatomical 
problems,  making  the  former  subservient  to  the  latter,  the 
subject  is  far  from  being  a  uniform  and  logically  de- 
veloped system  of  scientific  research.  It  represents  a  loosely 
connected  series  of  methods  and  amounts  to  just  as  much  as 
the  diagnostic  judgment,  skiagraphic  skill  and  reasoning 
power  of  the  individual  operator  will  allow.  It  seems  to 
me  that  the  topographic  landmarks  of  this  most  fascinating 
and  ever-important  subject  are  clearly  enough  marked  to 
admit  of  the  recognition  of  more  than  the  hitherto  accepted 
vague 'and  ill-defined  outlines. 

What  is  meant  by  a  good  X-ray  picture?  A  striking 
photographic  result  appeals  to  the  average  physician  be- 
cause it  possesses  the  elements  of  beauty  which  we  are  in 
the  habit  of  admiring  in  pictures  generally.  The  thoughtful 
radiographer,  especially  if  he  happens  to  be  a  good  surgical 
anatomist,  not  infrequently  remains  indifferent  at  the  sight 
of  what  others  rave  over,  and  often  becomes  interested  when 
others  see  nothing  of  any  consequence  in  a  skiagraph.  Why 
should  this  be  so?  The  reason  becomes  apparent  when  we 
consider  that  the  discriminating  power  of  the  eye  of  the 
layman  is  exercised  in  the  differentiation  of  lights  and 
shadows  and  the  relation  of  these  to  each  other.  The  eye 
i?  not  accustomed  to  any  other  kind  of  reasoning.  It  can 
appreciate  the  lights  and  shadows  of  the  real  object  and  can, 
therefore,  see  the  features  and  details  of  a  photograph  of 
the  real  object.  A  skiagraph  is  not  the  photographic  repro- 
duction of  a  real  object.  The  innumerable  waves  of  energy 
that  emanate  from  the  surface  of  the  X-ray  tube  and,  after 
traversing  space  and  penetrating  the  object,  strike  every 
point  of  the  exposed  sensitive  plate,  leave  a  sum-total  of  im- 
pressions behind  which  are  a  truthful  record  of  the  density 


X-RAY  DIAGNOSIS. 


269 


CHONDROMATA  ATTACHED  TO  BONES  OF  THE  HAND. 


270  Moni'K.x    I'IIYSIO-TIII-KAPY. 

of  the  object  at  every  point.  A  photograph  is  a  record  of 
impressions  made  by  rays  of  light  of  various  degrees  of  in- 
tensity from  the  object.  There  is  no  suggestion  of  density 
or  interception,  partial  or  complete,  of  light  rays. 

This,  however,  is  exactly  what  the  X-ray  picture  pre- 
sents. There  are  no  light-rays  coming  from  the  object. 
The  rays  go  through  the  object,  each  wave  encountering  a 
certain  resistance  determined  by  the  density  of  the  tissues 
traversed  by  that  particular  wave.  The  greater  the  degree 
of  density,  the  more  marked  will  be  the  interception  of  the 
quantity  of  force  represented  by  that  wave.  When  it  finally 
reaches  the  sensitive  plate,  it  leaves  at  one  point  a  record  of 
relative  density  of  the  tissues  traversed.  The  sum-total  of 
these  density  records  is  a  skiagraph.  The  latter  is  not  a 
picture  of  a  real  object,  but  the  pictorial  record  of  a  phys- 
ical characteristic  of  the  object.  The  skiagraph,  therefore, 
is  not  a  representation  of  an  object,  rather  an  abstraction 
from  an  object.  To  give  this  abstraction  a  physical  reality 
requires  the  application  of  a  radiographically  trained  eye 
and  mind.  The  failure  to  grasp  the  fundamental  difference 
between  a  photo-graph  (light-picture)  and  a  skia-graph 
(shadow-picture)  explains  many  errors  of  judgment  on 
the  part  of  not  a  few  X-ray  operators. 

Radiographic  Technique. 

The  process  of  taking  an  X-ray  picture  consists  of  the 
proper  use  of  five  different  elements  in  their  proper  rela- 
tion to  each  other : 

1.  The  machine  generating  the  form  of  electric  energy 
which  is  available  for  the  production  of  the  Roentgen-rays. 
The  static  machine  and  the  coil  are  the  generators  usually 
employed  for  this  purpose. 

2.  The  X-ray  tube  through  which  the  high-tension  cur- 
rent supplied  by  the  generator  is  transformed  into  X-ray 
energy.     The  transformation  is  consequent  upon    (i)   the 
concentration  of  the  cathodal  stream  in  a  point  upon  the 
anode  known  as  the  anodal  focus;   (2)   the  radiation  of 


TUBERCULAR  JOINT. 


S*R10STtUM    a  BONE 


SYPHILIS  OF  BONE. 


272  MODERN  PHYSIO-TIII.RAPY. 

electric  energy  from  the  anodal  focus  through  the  hemis- 
phere in  front  of  the  anode ;  and  ( 3 )  the  impingement  of 
electrified  molecules  of  ether  upon  the  inner  surface  of 
the  tube.  The  form  of  energy  which  is  generated  by  induc- 
tion on  the  outside  of  the  tube  is  known  as  X-rays. 

3.  A  device  by  which  other  forms  of  radiating  energy 
can  be  intercepted  and  thus  kept   from  mixing  with  the 
diverging  X-rays.       The   researches   of  Freund,    Walter, 
Tesla,   Stenbeck  and  Schiff  have  demonstrated  the  exist- 
ence of  different  forms  of  radiating  energy  emanating  from 
the  outer  surface  of  the  X-ray  tube  and  capable  of  affecting 
a  sensitive  photographic  film  after  penetrating  an  object, 
thus  leaving  a  shadow  wherever  they  have  struck  the  film. 
What  enormous  importance  this  fact  has  in  the  production 
of  a  photographic  result  we  shall  see  later  on. 

4.  The  object  to  be  skiagraphed  represents  a  mixture  of 
substances  of  various  degrees  of  density.     The  denser  the 
substance,  the  harder  it  is  to  penetrate  it  by  the  Roentgen- 
rays  and  the  fainter  will  be  the  shadow  on  the  film  after  the 
latter  has  been  developed  in  the  dark  room.     Then,  again, 
the  position  of  the  object  has  everything  to  do  with  the  pro- 
duction of  a  shadow-picture  (skiagraph)  on  the  film. 

5.  The  photographic  sensitive  plate  which  is  properly 
protected  against  the  actinic  rays  of  sunlight  or  artificial 
light  by  being  wrapped  in  a  black  and  in  an  orange-colored 
envelope. 

The  five  points  mentioned  indicate  the  necessary  tech- 
nical equipment  for  the  taking  of  an  X-ray  picture.  The 
first  and  last  (current-generator  and  photographic  plate) 
may  be  practically  left  out  of  consideration  because  their 
readiness  and  relative  fitness  for  radiographic  work  are 
taken  for  granted.  No  one  can  expect  to  do  good  radio- 
graphic  work  unless  he  has  the  tools  to  work  with.  The 
best  and  most  reliable  generator  for  X-ray  work  is  a  good, 
well-constructed  coil  (15  to  20  inch  spark-gap,  5.  TO  to  15 
amp.  capacity).  A  static  machine  is  capable  of  doin^  fairly 
good  work,  especially  if  its  efficiency  is  supported  by  a  good, 


X-R.\Y  DIAGNOSIS. 


273 


- 
o 


o 
- 
o 

H 

C/5 


274 


PHYSIO-THERAPY. 


well-adapted  tube.  Taking  it  for  granted  that  the  operator 
is  supplied  with  a  generator  of  suitable  capacity  and  that 
he  is  using  a  good  quality  of  photographic  plate,  the  dis- 
cussion of  the  technique  of  X-ray  photography  practically 
resolves  itself  into  a  detailed  consideration  of  (i)  the  tube, 
as  the  real  generating  source  of  X-ray  energy;  (2)  the  me- 
chanical device  which  is  to  intercept  foreign  and  disturbing 
forms  of  radiating  energy  and  known  as  the  X-ray  Camera ; 
and,  last  but  not  least,  the  density  and  the  position  of  the 
object. 


FIGURE  i. 

Geometrical  Features  of  Lines  of  Radiation. — The  lines 
or  waves  of  electric  energy  arise  or  emanate  from  the 
cathodal  surface  and  meet  in  a  point  on  the  anodal  disc  or 
plate.  The  concentration  of  cathodal  waves  in  one  point  is 
made  possible  by  the  construction  of  the  cathode.  The  lat- 
ter is  cup-shaped  and  represents  a  segment  of  a  globe.  The 
cathions  (smallest  particles  of  cathodal  electric  energy) 
arise  from  each  point  on  the  cathodal  surface  at  a  right 
angle  to  the  tangent.  In  Fig.  i,  A  B  represents  the  curve 
of  the  cathode.  C  D  is  a  tangent  touching  the  curve  at  E. 


X-RAY  DIAGNOSIS. 


275 


A  wave  of  cathodal  energy  arises  at  E  at  a  right  angle  to 
CD.  F  is  a  point  on  the  anodal  disc  in  which  all  cathodal 
waves  meet.  The  dotted  lines  represent  two  more  waves 
and  the  tangents  of  the  points  of  issue.  F  is  known  as  the 
anodal  focus  which  does  not  necessarily  represent  the  center 
of  the  anode  (G  H).  From  the  anodal  focus  (F),  where 
the  cathodal  rays  meet  and  are  united  with  the  anions 
(smallest  particles  of  anodal  electric  energy),  radiation  of 


FIGURE  2. 

force-waves  takes  place  in  all  directions  in  front  of  the 
anodal  disc.  Thus  the  tube  when  lighted  up  shows  the 
hemisphere  in  front  of  the  plane  of  the  anode  aglow  with 
a  characteristic  greenish  light,  while  the  hemisphere  back 
of  the  anodal  plane  remains  dark.  When  the  radiation  from 
the  anodal  focus  takes  place,  causing  electrified  molecules 
of  ether  to  impinge  upon  the  inner  surface  of  the  tube,  the 
outer  surface  of  the  latter  gives  rise  to  peculiar  phenomena 
of  force-production.  Different  kinds  of  waves  of  ray- 
energy  arise  from  this  outer  surface,  among  them  the  waves 


276 


MODERN  PHYSIO-THERAPY. 


of  that  mysterious  force  discovered  by  Roentgen  and  called 
by  him  the  unknown-quantity-rays  or  the  X-rays. 

The  X-rays  arise  on  the  outer  surface  of  the  tube  at  right 
angles  to  the  tangents  of  their  points  of  issue.  In  Fig.  2, 
BAG  represents  a  segment  of  an  X-ray  tube.  The  wave  of 
energy  which  arises  at  F  (anodal  focus)  and  impinges  upon 
the  inner  surface  of  the  tube  at  A,  is,  by  induction,  trans- 
formed into  an  X-ray  (A  G)  which  begins  at  A  (outer  sur- 


-1-7 


FIGURE  3. 


face)  and  is  practically  a  continuation  of  F  A.  D  E  is  the 
tangent  of  the  point  of  issue  (A).  For  practical  purposes 
we  may  look  upon  F  as  being  the  source  of  the  X-rays  and 
the  center  of  the  X-ray  hemisphere.  I  shall  refer  to  it  in 
this  way  hereafter.  In  Fig.  3  the  relation  of  the  X-rays  to 
a  photographic  plate  is  diagrammatically  shown. 

&  B  is  the  segment  of  an  X-ray  tube.  Rays  emanating 
/rom  F  strike  a  photographic  plate  (a  f )  which  is  lying  on  a 
teble  or  some  other  solid  support.  It  will  be  noticed  that 


X-RAY  DIAGNOSIS. 


277 


the  anode  is  parallel  to  the  photographic  plate.  This  is  tke 
ideal  relation  of  the  two.  One  ray  emanates  at  right  angles 
from  F  and  strikes  the  plate  at  right  angles  (c),  anode  and 
plate  being  parallel.  The  rays  which  strike  the  plate  at  a 
or  at  b  or  at  d  or  at  e  or  at  /  increase  in  length  the  further 
they  are  removed  from  the  median  line  (F-c).  This  median 
line  is  the  shortest  line  because  it  strikes  the  plate  at  right 
angles.  This  line  is  of  the  greatest  importance  in  X-ray 


FIGURE  4. 

photography.  It  is  known  as  the  anodal  axis.  Remember 
this  definition  once. for  all:  A  line  drawn  from  the  anodal 
focus  to  the  photographic  plate  at  right  angles  to  the  latter, 
is  known  as  the  anodal  axis,  and  is  the  shortest  line  between 
anodal  focus  and  plate. 

The  anodal  disc  and  the  photographic  plate,  however, 
do  not  necessarily  have  to  be  parallel.  In  Fig.  4  the  anode 
and  the  photographic  plate  are  not  parallel.  F-c  is  the 
anodal  axis.  It  makes  no  difference  how  the  X-ray  tube  is 


278  MODERN  PHYSIO-THERAPY. 

placed ;  the  photographic  plate  or,  for  that  matter,  the  ob- 
ject placed  above  it,  should  be  struck  by  the  anodal  axis  in 
or  near  the  center.  If  this  rule  is  not  followed,  distortion 
of  the  shadow-picture  is  bound  to  occur.  To  illustrate  this 
point,  make  the  following  simple  experiment : 

Take  a  book  in  your  right  hand  and  a  lighted  candle  in 
the  left.  Hold  the  book  six  inches  away  from  the  wall  and 
parallel  to  the  latter.  Hold  the  candle  six  inches  away  from 
the  book  in  a  line  corresponding  to  the  center  of  the  book. 
The  shadow  of  the  book  on  the  wall  will  be  larger  than 
the  book.  If  you  keep  the  book  stationary  and  move  the 
candle  away  from  it,  the  shadow  of  the  book  will  become 
smaller.  If  you  move  the  candle  toward  the  book,  the 
shadow  will  enlarge.  If  you  keep  the  candle  stationary,  but 
move  the  book  toward  or  away  from  the  wall,  the  shadow 
will  become  smaller  or  larger,  as  the  case  may  be.  As  long 
as  the  book  and  the  wall  are  parallel  and  the  source  of  light 
remains  in  the  median  line,  the  shadow  may  be  large  or 
small,  it  will  be  a  proportionate  representation  of  the  book. 
If  you  move  the  candle  out  of  the  median  line  or  if  you  hold 
the  book  slanting  toward  the  wall,  a  distorted  shadow  will 
be  the  result.  The  wall  in  this  case  represents  the  photo- 
graphic plate,  the  candle-light  is  the  anodal  focus.  The 
median  line  is  the  anodal  axis.  What  principles  does  this 
simple  illustration  convey? 

1.  Avoid  too  large  a  shadow,  i.  e.  put  the  object  as  close 
to  the  plate  as  possible ; 

2.  The  plane  of  the  object  should  be  parallel  to  the 
photographic  plate ; 

3.  The  object  should  not  be  beyond  the  sphere  of  radio- 
activity of  the  excited  tube ; 

4.  The  anodal  axis  should  pass  through  the  center  or 
through  the  most  important  part  of  the  object. 

Fig.  3  exemplifies  these  principles.  C  D  represents  an 
object  placed  parallel  to  the  photographic  plate  (a-f).  The 
shadow  of  the  object  (E  G)  is  larger  than  the  object  (C  D). 
If  C  D  were  closer  to  the  plate  (a-f),  its  shadow  would  be 


X-RAY  DIAGNOSIS.  279 

more  nearly  the  size  of  the  object.  F-c  is  the  anodal  axis 
passing  through  the  object  through  or  near  its  most  impor- 
tant part.  If  C  D  represents  a  hand  which  is  supposed  to 
contain  a  needle  or  some  other  foreign  body,  we  would 
place  the  hand  directly  upon  the  photographic  plate  and 
allow  the  anodal  axis  to  pass  through  the  supposed  location 
of  the  foreign  body  (H).  Let  C  D  represent  the  region  of 
the  hip- joint.  We  will  place  the  object  in  such  a  position 
that  the  point  of  greatest  interest  (for  instance,  the  sup- 
posed seat  of  a  fracture)  is  in  the  anodal  axis. 

There  is  another  reason  w^hy  the  anodal  axis  represents 
the  most  important  line  of  X-ray  energy.  The  power  of 
the  X-ray  decreases  in  proportion  to  the  distance  between 
anodal  focus  and  object.  The  longer  the  ray,  the  weaker  it 
becomes.  Since  the  anodal  axis  is  the  shortest  line  between 
anodal  focus  and  object,  it  is  necessarily  the  most  powerful 
— quod  erat  demonstrandum. 

The  Question  of  Vacuity. — The  vacuum  of  the,  tube  is 
the  physical  condition  of  the  latter  produced  by  more  or  less 
perfect  exhaustion.  The  more  perfectly  the  tube  is  ex- 
hausted, the  greater,  of  course,  is  the  pressure  or  tension. 
The  tube  is  called  a  high  or  a  hard  tube  if  the  exhaustion  is 
relatively  perfect.  Depending  on  the  degree  of  exhaustion, 
the  tube  may  be  high  (hard),  moderately  high  (hard), 
moderately  low  (soft),  low  (soft).  In  the  low  (soft)  tube 
the  exhaustion  is  relatively  imperfect,  /.  e.  the  pressure  or 
tension  is  low.  If  the  pressure  or  tension  is  too  low,  i.  e. 
if  the  tube  is  too  soft,  there  will  be  no  X-rays  produced. 

The  shadows  which  a  hard  tube  casts  upon  the  fluoro- 
scopic  screen,  are  very  light.  The  bone-shadows  even  are 
faint.  The  less  hard  the  tube  is,  the  more  distinct  will  be 
the  shadows,  the  more  marked  will  be  the  difference  be- 
tween the  shadows  of  the  soft  and  hard  tissues.  The  typical 
X-ray  picture  of  the  hand  (faint  shadows  of  the  soft  tissues, 
dark  and  well  defined  shadows  of  the  bones)  is  produced  by 
a  moderately  soft  tube.  The  softer  the  tube,  the  more  easily 
are  the  X-rays  which  are  produced  by  it  intercepted  by  an 


280  MODERN  PHYSIO-THERAPY. 

interposed  object.  This  is  because  the  softer  the  tube,  the 
less  penetrating  are  its  X-rays.  A  thin  part,  like  the  hand, 
offers  but  little  resistance  to  the  waves  of  X-ray  energy  com- 
ing from  the  tube.  For  this  reason,  penetration  is  easily 
effected.  Everybody  is  familiar  with  the  skiagraphic  or 
fluoroscopic  picture  of  a  hand.  The  greater  density  of  the 
bony  tissue  makes  the  shadows  of  the  phalanges  darker  than 
the  shadows  of  the  soft  parts,  which  are  less  dense  and, 
therefore,  cast  a  lighter  shadow.  The  point  to  be  remem- 
bered is  that  it  is  not  a  question  of  thickness,  but  of  density. 
It  makes  no  difference  whether  we  lessen  the  transverse 
diameter  of  a  part  by  pressure  and  thus  make  the  part 
thinner.  Compression  of  a  part  diminishes  the  thickness, 
but  does  not  change  the  density.  The  tissues  are  matted  to- 
gether, occupy  less  space,  but  are  not  rendered  less  dense. 
It  is  plain,  therefore,  that  compression  of  an  object,  while  it 
may  lessen  the  distance  between  tube  and  object,  does  not 
change  the  density  of  the  object.  This  is  a  point  of  some 
importance  in  connection  with  skiagraphic  technique. 

The  vacuity  of  the  tube  suggests  the  law  which  under- 
lies the  adaptation  of  the  excited  X-ray  tube  to  any  skia- 
graph or  therapeutic  purpose,  to  wit : 

"Hard  tube,  scant  output,  great  penetration;  soft  tube, 
copious  output,  slight  penetration." 

The  conclusions  to  be  drawn  from  this  well-established 
law  are: 

1.  Use  a  relatively  hard  tube  whenever  a  high  degree  of 
density  is  to  be  overcome.    The  harder  the  tube,  the  greater 
its  penetrating  power.    The  harder  the  tube,  the  longer  the 
exposure  of  a  deep  part  on  account  of  the  scant  output  of 
energy.     The  harder  the  tube,  the  slighter  its  therapeutic 
usefulness.     The  hard  tube  is  the  skiagraphic  tube  par  ex- 
cellence. 

2.  Use  a  relatively  soft  tube  in  skiagraphing  thin  parts 
which  do  not  require  much  penetration.     The  softer  the 
tube,  the  more  intense  its  effect  on  superficial  parts  on  ac- 
count of  the  copious  output  of  energy  and  comparatively 


X-RAY  DIAGNOSIS.  281 

slight  penetrating  power.  The  softer  the  tube,  the  greater 
its  therapeutic  usefulness.  The  soft  tube  is  the  therapeutic 
tube  par  excellence.  The  proper  therapeutic  field  of  the 
X-rays  is  the  skin  and  the  subcutaneous  tissues. 

In  gauging  the  thickness  of  a  part,  the  question  of 
density  is  of  prime  importance.  Three  inches  of  soft  tissue 
are  not  by  any  means  as  hard  to  penetrate  as  three  inches 
of  bony  tissue.  In  gauging  the  diameter  of  a  portion  of 
the  body,  it  is  principally  the  bulk  of  its  bony  structure 
which  we  are  interested  in. 

The  length  of  exposure  depends  on  the  thickness  and 
density  of  the  object  and  the  degree  of  exhaustion  of  the 
tube.  In  recent  times  there  has  been  much  talk  about  in- 
stantaneous skiagraphy  (X-ray  snapshots).  As  far  as  my 
experience  has  taught  me,  instantaneous  X-ray  photography 
does  not  exist,  except  in  the  minds  of  overanxious  coil- 
agents  or  visionary  optimists.  To  be  able  to  time  and  ex- 
posure properly,  is  largely  a  matter  of  experience.  There 
are  no  iron,-clad  rules  by  which  the  operator  can  be  safely 
guided.  Experience,  backed  up  by  positive  knowledge  of 
the  subject,  is  in  this,  as  in  many  other  lines,  the  conditio 
sine  qua  non  of  scientific  and  successful  work.  It  is  the 
wall  that  separates  the  amateur  from  the  master,  the  me- 
chanic from  the  scientist.  Let  the  X-ray  operator  remem- 
ber that  short  exposures  (3-5  seconds)  refer  to  skiagraphy 
of  very  thin  parts,  the  tube  used  being  moderately  soft. 
The  thicker  and  denser  the  part,  the  longer  should  be  the 
exposure,  the  harder  should  be  the  tube.  An  exposure  of 
three  minutes  to  skiagraph  the  spine  of  a  medium-sized 
adult  by  means  of  a  tolerably  hard  tube,  is  not  too  long.  I 
have  made  exposures  of  five  minutes'  duration  with  splendid 
results.  Operators  who  use  static  machines  will  have  to 
expose  two  and  even  three  times  as  long  as  those  who  work 
with  good-sized  coils.  On  general  principles  I  feel  that  it  is 
better  to  over-expose  than  to  under-expose  a  tolerably  deep 
structure.  Most  failures  in  these  cases  are  due  to  under- 
exposure. With  a  moderately  soft  tube  the  duration  of  an 
exposure  should  be : 


282  MODERN  PHYSIO-THRRAPY. 

For  a  medium-sized  hand  10-20  seconds ; 
For  a  medium-sized  wrist  15-25  seconds; 
For  a  medium-sized  elbow  20-30  seconds ; 
For  a  medium-sized  shoulder  40-60  seconds ; 
For  a  medium-sized  ankle,  20-40  seconds ; 
For  a  medium-sized  knee  30-60  seconds. 


X-RAY  COIL  SHOWING  INTERRUPTERS  FOR  DIRECT  AND 
ALTERNATING  CURRENT. 

With  a  tolerably  hard  tube  the  duration  of  an  exposure 
should  be : 

For  a  medium-sized  hip  1-3  minutes ; 

For  the  spine  of  an  adult  2^2-4  minutes. 

Large  coils  with  an  immense  output  of  current  lessen 
the  time  of  exposure.  Much  depends  on  the  steadiness  of 


X-RAY  DIAGNOSIS.  283 

the  tube.  Some  tubes  do  not  hold  out  well,  but  become 
gradually  softer  while  the  exposure  is  being  made.  All 
these  uncertainties  affect  the  modus  operandi  in  a  given 
case.  The  only  criterion  to  go  by,  therefore,  is  the  per- 
sonal equation  of  the  operator.  Theoretical  skiagraphy  is 
a  myth.  Experience  alone  gives  it  a  place  in  the  diagnostic 
armamentarium  of  modern  medicine.  Vice  versa,  expe- 
rience is  of  little  value  unless  it  embraces  the  knowledge  of 
the  Why  ?  and  the  Wherefore  ?  It  is  theoretical  knowledge 
that  places  upon  experience  the  stamp  of  authority. 

Tangential  Radiations. — Reference  has  already  been 
made  to  a  peculiar  form  of  radiation  first  described  by  Wal- 
ter under  the  name  of  secondary  radiations.  There  seems 
to  be  sufficient  evidence  to  show  that  these  radiations  come 
directly  from  within  the  tube,  and  belong  under  the  general 
head  of  ultra-violet  rays.  The  radiations  coming  from  the 
extreme  red  end  of  the  spectrum  are  characterized  by  short 
waves  and  comparatively  slow  vibrations.  As  we  approach 
the  violet  end,  the  waves  increase  in  length  and  in  rapidity 
of  vibration.  We  also  know  that  the  angle  of  refraction  be- 
comes more  acute  as  we  leave  the  red  and  approach  the 
violet  field.  Adding  to  this  fact  the  positively  known  pas- 
sage of  true  chemical  rays  from  the  inside  of  the  tube 
through  the  glass,  we  have  no  hesitancy  to  identify  those 
rays  which  have  been  described  as  Walter's  secondary  or 
tangential  radiations.  They  are  without  a  doubt  these  in- 
tratubular  chemical  (ultra-violet)  rays  refracted  by  the 
glass  wall  of  the  tube  which  acts  like  a  prism.  After  being 
thus  refracted  they  pursue  a  straight  path,  intersecting  the 
diverging  X-rays  and  penetrating  any  obstacle  as  far  as 
their  carrying  power  will  permit,  and  possibly  being  again 
deflected  from  their  path  if  they  should  meet  with  any  ob- 
stacle capable  of  refracting  and  deflecting  them.  (See 

Fig-  5-) 

In  this  way  they  may  reach  a  sensitive  plate,  leaving  a 
faint  density-record  upon  it,  which,  of  course,  will  not  coin- 
cide with  the"  X-ray  shadow,  but  as  a  secondary  shadow,  not 


284  MODERN  PHYSIO-THERAPY. 

sufficiently  well  marked  to  possess  any  individuality,  but  just 
enough  to  have  a  blurring  effect.  This  blurring  effect 
causes  the  X-ray  outlines  of  a  picture  to  appear  less  sharp 
and  well-defined.  As  a  result,  we  get  flat  X-ray  shadows, 
without  character,  detail  or  perspective,  whenever  we  at- 
tempt to  make  a  direct  exposure  of  an  object  to  the  X-ray 
tube.  A  device  for  the  interception  of  the  tangential  rays 


has  become  a  necessity  without  which  skiagraphic  work 
nowadays  is  practically  impossible.  In  the  light  of  modern 
radiologic  observations  it  would  not  be  preposterous  to  as- 
sume an  active  phosphorescent  state  of  the  tissues,  produced 
by  the  diffused  tangential  radiations  and  the  absorption  of 
the  X-rays  by  the  blood  (pigment  of  the  red  blood-cells). 
This  phosphorescent  state  has  been  explained  as  being  due 
to  the  absorption  of  the  X-rays  by  the  hemoglobin.  That 
the  X-rays  do  not  represent  the  only  force-modality  given 


X-RAY  DIAGNOSIS.  285 

off  by  the  X-ray  tube,  is  generally  admitted.  The  sum-total 
of  energy  generated  is  composed  of  high-tension  electricity 
(sparks,  brush-discharges  and  a  surplus  of  static  electrical 
force  which  accumulates  within  the  magnetic  field  of  the 
tube),  heat-rays,  ozone,  dynamic  waves,  induction-products 
and  many  other  forms  of  force-manifestation  mentioned  by 
numerous  authors  (Freund,  Schiff,  Bang,  Tesla,  Kaposi, 
etc.). 

In  order  to  increase  the  beauty  and  usefulness  of  an 
X-ray  picture,  an  attempt  should  be  made  to  bring  out  de- 
tails and  lines  with  more  precision.  To  prevent  the  phos- 
phorescence of  the  tissues  and  to  intercept  the  so-called  tan- 
gential radiations  is  nowadays  an  important  part. of  skia- 
graphic  technique.  The  more  successful  we  are  in  this,  the 
clearer  and  better  defined  will  be  the  outlines  of  the  shadows 
even  of  faint  and  insignificant  details.  We  must  prevent  the 
phosphorescence  of  the  tissues  produced  by  the  indiscrim- 
inate diffusion  of  secondary  radiations.  To  accomplish  this 
purpose  the  German  investigators,  notably  Albers-Schoen- 
berg,  use  an  'adjustable  lead-lined  cylinder  which  is  inter- 
posed between  the  tube  and  the  object  and  allows  a  cone  of 
X-ray  energy  to  pass  through  it  down  to  the  object  and  sen- 
sitive plate.  The  tangential  rays  are  held  up  by  the  cylin- 
der and  are  thus  prevented  from  scattering  through  the 
object.  The  Germans  call  this  device  a  Blende  (a  "blind," 
device  to  keep  side-lights  out  of  horses'  eyes).  "Com- 
pression-diaphragm" is  a  bunglesome  translation,  because 
the  device  is  neither  a  diaphragm  nor  does  it  compress. 
Since  the  "Blende"  is  analogous  to  the  camera  in  photog- 
raphy which  gathers  in  the  desirable  rays  and  shuts  out 
side-rays,  it  seems  to  me  that  the  term  X-ray  Camera  is  the 
best  and  most  befitting  appellation.  A  very  useful  device 
of  this  kind  is  on  the  American  market  under  the  name  re- 
ferred to. 

The  Interception  of  Secondary  Radiations. — The  X-ray 
camera,  as  the  name  indicates,  is  a  chamber  (camera)  for 
the  reception  and  transmission  of  X-rays  and,  we  might  add, 


286  MODERN  PHYSIO-THERAPY. 

for  the  exclusion  of  other  forms  of  radio-activity.  It  is  an 
open  cylinder  which  is  interposed  between  the  X-ray  tube 
and  the  sensitive  plate  upon  which  the  object  rests.  The 
cylinder  is  adjustable  to  any  position,  perpendicular,  tilting, 
high  or  low.  Its  length  can  be  regulated.  By  means  of 
suitable  diaphragms  the  cone  of  light  passing  through  the 
cylinder  can  be  reduced  to  any  thickness.  The  X-ray  tube 
can  be  placed  in  any  desirable  position  above  the  cylinder. 
The  mechanical  adjustments  for  both  cylinder  and  tube  are 
simple  and  easily  handled.  The  whole  apparatus  is  mounted 
in  such  a  way  that  it  can  be  placed  on  any  table  and  is 
always  ready  for  work.  Some  prefer  it  to  be  suspended 
from  the  ceiling  directly  above  the  table.  It  can  be  imme- 
diately put  out  of  the  way  when  the  patient  is  ready  to 
leave  the  table.  However,  the  question  of  choosing  between 
a  stationary  or  swinging  type  of  camera  is  purely  a  matter 
of  taste.  Fig  8  is  a  diagrammatic  representation  of  the 
X-ray  Camera. 

Figures  6  and  7  show  the  modus  operandi  of  the  camera. 
C  H  I  G  is  the  cylinder,  C  D  E  G  representing  the  trans- 
verse section  of  a  diaphragm  placed  inside.  The  lines  from 
F  represent  the  X-rays,  the  broken  lines  coming  from  the 
surface  of  the  tube  being  the  tangential  or  secondary  rays. 
The  X-rays  pass  through  the  cylinder  (C  H  I  G),  through 
the  object  (K  L)  to  the  plate  (M  N).  The  tangential  rays 
are  stopped  by  the  diaphragm  (CD  and  E.  G.)  and  by  the 
cylinder.  In  both  figures  one  tangential  ray  is  seen  passing 
through  the  object  to  the  plate.  This  indicates  the  necessity 
of  being  able  to  elongate  the  cylinder  and  to  adjust  different 
sizes  of  diaphragms. 

In  order  to  understand  the  disturbing  role  which  the 
tangential  rays  play,  it  is  only  necessary  to  think  of  the  il- 
lustration previously  referred  to.  Let  us  imagine  the  book 
six  inches  away  from  and  parallel  to  the  wall.  The  candle- 
light in  the  median  line  represents  the  X-rays  coming  from 
the  anodal  focus.  Let  us  hold  a  smaller  light  near  the 
candle-light.  The  result  will  be  the  production  of  a  second 


X-RAY  DIAGNOSIS. 


287 


but  much  fainter  shadow  of  the  book  on  the  wall.  The  ad- 
ditional light  represents  the  tangential  energy  coming  from 
the  surface  of  the  tube  or  Walter's  "secondary  radiations." 
These  tangential  rays  are  responsible  for  the  poor  results 
which  follow  free  exposures  without  any  attempt  to  inter- 


FIGURE)  6. 

cept  or  eliminate  these  disturbing  rays.  The  pictures  are 
flat  and  ill-defined,  without  character,  expression  and  per- 
spective. 

The  ideal  position  for  the  cylinder  is  at  right  angles  to 
the  plate  so  that  the  anodal  axis  and  the  axis  of  the  cylinder 


288 


MODERN  PHYSIO-THERAPY. 


(line  through  the  center)  will  coincide.  In  this  ideal  posi- 
tion a  cone  of  X-ray  radiance  will  fall  through  the  object 
upon  the  plate,  the  base  of  the  cone  being  the  exposed  part 
of  the  plate,  the  apex  being  the  anodal  focus.  The  transverse 
diameters  of  the  cone  will  depend  on  the  size  of  the  opening 


in  the  diaphragm  and  the  length  of  the  cylinder.  To  put 
the  cylinder  in  this  ideal  position,  place  the  anodal  focus 
directly  over  the  axis  of  the  cylinder,  the  latter  being  at 
right  angles  to  the  plate.  The  anodal  disc  may  be  parallel 
to  the  sensitive  plate  or  may  not.  The  parallel  position  is 
the  ideal  position.  The  essential  point  is  that  the  anodal 


X-RAY  DIAGNOSIS.  289 

focus  be  in  the  longitudinal  axis  (central  line)  of  the  cylin- 
der. The  position  of  the  anodal  disc  with  reference  to  the 
cylinder  is  theoretically  immaterial,  practically  dependent 
on  certain  conditions  of  convenience.  If  it  is  parallel  to  the 
sensitive  plate  which  is  lying  horizontally  on  a  solid  base, 
such  as  a  table,  the  adjustment  of  the  whole  arrangement 
from  plate  up  to  the  tube  is  simple.  The  longitudinal  axis 
of  the  cylinder  strikes  the  anodal  focus  above  and  the  cen- 
ter of  the  sensitive  plate  below.  It  is  needless  to  say  that 
it  strikes  the  anodal  plane  and  the  sensitive  plate  at  right 
angles,  the  two  being  parallel.  Thus  we  get  a  cone  of  light, 
whose  apex  is  the  anodal  focus,  whose  base  is  the  circle  of 
light  corresponding  to  the  shape  of  the  lower  end  of  the 
camera-cylinder  from  which  the  symmetrically  diverging 
rays  emerge.  The  principal  part  of  the  arrangement  is  that 
the  anodal  focus  is  strictly  in  line  with  the  longitudinal  axis 
of  the  cylinder.  Hence  it  makes  no  material  difference 
whether  we. place  the  anode  parallel  to  the  sensitive  plate 
or  not.  Even  if  the  anodal  plane  were  not  parallel  to  the 
plate,  the  anodal  focus  being  in  the  median  line  (longi- 
tudinal axis),  the  cone  of  the  light  would  remain  the  same. 
An  entirely  different  effect  would  result  if  the  anodal  focus 
were  not  in  the  median  line.  The  cone  of  the  light  would 
be  distorted,  the  rays  striking  the  plate  at  different  angles. 
The  anatomical  peculiarities  of  certain  regions  of  the  body 
sometimes  make  it  imperatively  necessary  to  tilt  the  cylinder 
and  allow  the  rays  to  strike  the  object  and  plate  obliquely. 
What  I  have  previously  stated  concerning  slanting  rays  and 
resulting  distortion  of  the  shadow,  should  be  remembered 
in  taking  the  picture  and  in  interpreting  the  skiagraphic 
result. 

Let  us  illustrate  these  points  by  a  pertinent  example. 
We  are  about  to  take  an  X-ray  picture  of  a  bullet  which  is 
lodged  somewhere  in  the  lumbar  spine.  In  placing  the  pa- 
tient over  the  photographic  plate,  we  would  put  him  on  his 
back  in  order  to  get  the  bullet,  which  in  this  case  is  the 
object,  as  close  to  the  plate  as  possible.  (If  the  bullet  is 


290 


MODERN  PHYSIO-THERAPY. 


supposed  to  be  near  the  abdominal  wall,  the  patient  would, 
of  course,  be  put  on  his  stomach.)  The  cylinder  is  placed 
over  the  abdomen  directly  over  the  supposed  location  of 
the  foreign  body.  The  X-ray  tube  of  proper  internal  re- 


8. 


sistance  is  in  its  proper  position  over  the  cylinder.  The 
anodal  axis  passes  from  the  anodal  focus  through  the  space 
intervening  between  the  tube  and  the  upper  rim  of  the  cylin- 
der. It  passes  through  the  center  of  the  cylinder,  then 


X-RAY  DIAGNOSIS. 


291 


through  the  patient's  abdomen,  through  or  near  the  foreign 
body  down  to  the  plate.  This  is  the  ideal  mode  of  proced- 
ure, because  the  shadow-picture  will  be  an  approximately 
correct  reproduction  of  the  region  X-rayed.  There  will  be 
no  distortion,  because  the  anodal  axis  passes  through  the 
median  line  and  strikes  the  plate  at  right  angles.  In  Fig.  9 


F  represents  the  anodal  focus,  the  anodal  disc  being  shown 
in  two  positions,  parallel  and  oblique.  F  B  C  is  the  cone  of 
light,  whose  diameter  is  determined  by  the  size  of  the  lower 
opening  of  the  cylinder  D  F  E  G,  through  which  the  rays 
pass.  F  A  is  the  longitudinal  axis,  which  coincides  with  the 
median  line  of  the  cone.  The  diffusion  of  light  is  symmetri- 


292  MODERN  PHYSIO-THERAPY. 

cal.  The  dotted  lines  represent  the  effect  which  is  produced 
by  the  anodal  focus  being  away  from  the  median  line  of  the 
cylinder,  as  a  result  the  cone  is  distorted,  which  in  skiag- 
raphy  is  equivalent  to  an  asymmetrical  distortion  of  the 
shadows. 

In  order  to  immobilize  the  object  to  be  skiagraphed  it  is 
not  necessary  to  compress  it  because  lessening  of  the  bulk 
does  not  mean  reduction  of  density.  Compression  is  not 
only  unnecessary,  but  in  many  instances  decidedly  unde- 
sirable. Aside  from  the  discomfort  which  a  patient  is  bound 
to  suffer,  a  certain  change  of  relative  location  or  a  malposi- 
tion of  the  parts  is  liable  to  occur  and  thus  a  diagnostically 
worthless  picture  is  apt  to  result.  This  is  especially  the  case 
when  we  are  dealing  with  a  freely  movable  foreign  body. 
Aside  from  the  damage  which  is  liable  to  be  inflicted  upon 
the  surrounding  tissues  by  sharp  and  pointed  contour  of  a 
foreign  body,  compression  of  the  part  containing  the  for- 
eign body  is  certain  to  change  the  relative  position  of  the 
latter,  the  change  of  position  being  determined  by  the 
tendency  of  the  foreign  body  to  move  in  the  direction  of 
least-  resistance,  i.  e.  away  from  hard  or  resisting  tissue  and 
in  the  direction  of  soft,  non-resisting  tissue. 

I  have  demonstrated  this  point  to  my  satisfaction  before 
the  class  of  the  "Cincinnati  Post-graduate  School  of  Physio- 
logical Therapeutics"  by  skiagraphing  a  bullet  which  was 
imbedded  in  the  fleshy  part  of  the  thigh.  By  using  a  so- 
called  compression-diaphragm  I  was  able  to  obtain  six  dif- 
ferent X-ray  pictures  of  the  subject,  no  two  pictures  show- 
ing the  foreign  body  in  the  same  relative  position.  I  could 
have  added  pictures  of  the  same  subject  ad  libitum,  the  de- 
gree and  direction  of  the  pressure  determining  the  skia- 
graphic  result.  There  is  not  the  least  doubt  that  com- 
pression is  theoretically  wrong  and  practically  misleading 
to  the  surgeon  and  uncomfortable  to  the  patient.  The  idea 
of  compression  was  probably  suggested  by  a  misconception 
of  the  principle  of  immobilization,  which  in  skiagraphy  as 
well  as  in  photography  is  a  factor  of  prime  importance. 


X-RAY  DIAGNOSIS.  293 

Since  snapshots  are  unknown  in  X-ray  work,  the  objects 
we  attempt  to  skiagraph  must  remain  unmoved  during  the 
time  of  exposure.  To  aid  in  preventing  change  of  position, 
we  can  immobilize  almost  every  object  in  a  simple,  effective 
and  painless  manner.  This  is  accomplished  by  mere  con- 
tact with  or  very  gentle  pressure  of  the  lower  end  of  the 
cylinder  which  is  interposed  between  tube  and  object  for 
the  purpose  of  eliminating  various  disturbing  forms  of  ray- 
energy  emanating  from  the  X-ray  tube  and  interfering  with 
the  X-rays  proper.  . 

PRACTICAL  SUGGESTIONS. — Always  remember — 

1.  That  the  object  should  be  as  close  to  the  plate  as 
possible,  so  that  too  large  a  shadow  may  be  avoided ; 

2.  That  the  planes  of  object  and  plate  should  be  parallel ; 

3.  That  the  object  should  be  within  the  radio-active  field 
of  the  tube ; 

4.  That  the  anodal  focus  should,  if  possible,  be  directly 
over  the  center  of  the  object ; 

5.  That  in  placing  an  object  beneath  the  cylinder  of  the 
camera  for  the  purpose  of  skiagraphing  it,  no  removable 
foreign  substance,  e.  g.  clothing,  should  intervene  between 
the  cylinder  and  the  object  or  the  object  and  the  sensitive 
plate ; 

6.  That,  in  order  to  protect  the  plate  against  heat  and 
moisture  it  is  sometimes  permissible  or  even  necessary  to 
put  one  or  more  blotters  or  a  layer  of  some  water-proof 
non-opaque  material  between  object  and  plate  (e.  g.  in  ab- 
dominal work  on  fat  persons  or  if  the  exposures  are  long)  ; 

7.  That  the  plate  should  not  be  brought  into  the  room 
until  everything  is  ready; 

8.  That  a  skiagraphic  error  is  always  due  to  some  short- 
coming on  the  part  of  the  operator-  either  in  placing  the  ob- 
ject, in  making  the  exposure  or  in  interpreting  the  result; 

9.  That  the  relatively  good  result  will  depend  on  the 
knowledge  of  the  vacuity  of  the  tube,  on  the  adaptation  of 
the  tube- vacuum  to  the  density  of  the  object  and  on  the 
proper  timing  of  the  exposure; 


294  MODERN  PHYSIO-THERAPY. 

10.  That  a  good  home-made  substitute  for  the  camera 
consists  in  a  piece  of  sheet-lead  with  a  circular  opening  in 
the  center,  the  lead  being  turned  up  two  or  three  inches 
along  the  periphery  of  the   opening    (the  object   is  skia- 
graphed  through  this  opening,  the  lead  being  laid  on  the 
object)  ; 

11.  That  X-ray  exposures,  especially  of  deep  parts,  are 
frequently  undertimed ; 

12.  That  it  is  incomparably  easier  to  become  a  good 
X-ray  photographer  than  it  is  to  be  a  reliable  X-ray  diag- 
nostician.    It  is  simple  to  take  a  picture,  but  by  no  means 
so  easy  to  interpret  it. 

The  Photographic  Part  of  the  Work. 

The  exposure  having  been  made,  the  plate  is  taken  into 
the  dark  room,  and  there  taken  out  of  the  two  envelopes 
and  put  in  the  developing  fluid.  In  order  to  do  this  portion 
of  the  work  successfully  it  is  necessary  to  understand  the 
elements  of  photography  and  photographic  technique. 

The  film  which  is  on  one  side  of  the  glass  plate  is  called 
sensitive  because  it  contains  silver  which  is  sensitive  to  the 
action  of  actinic  rays.  Corresponding  to  the  relative  in- 
tensity of  these  rays  there  is  a  chemical  change  in  the  silver. 
This  change  becomes  apparent  to  the  human  eye  the  mo- 
ment the  plate  is  acted  upon  by  a  "developing"  fluid.  The 
film  becomes  transparent  showing  the  discoloration  in  the 
silver.  Some  parts  are  strongly  discolored,  others  less  so, 
still  others  hardly  discolored  at  all.  Where  no  light  has 
struck  the  film,  no  discoloration  is  seen,  i.  e.  the  film  is  ab- 
solutely transparent.  It  is  the  manifold  degrees  of  dis- 
coloration of  the  silver  that  constitute  the  picture.  Wher- 
ever an  intense  action  of  actinic  rays  has  taken  place,  a  cor- 
respondingly strong  discoloration  is  seen,  i.  c.  the  impres- 
sion left  by  the  rays  is  black.  \Vhere  only  a  faint  action  oc- 
curred, the  discoloration  is  slight.  Thus  the  lights  and 
shadows  of  the  object  are  reversed  in  the  reproduction  on  an 
exposed  plate.  Photographers  call  such  a  picture  a  nega- 


X-RAY  DIAGNOSIS.  295 

tive.  The  white  face  of  a  man  is  black  in  the  negative, 
while  his  black  coat  is  represented  by  a  portion  of  the  film 
which  has  hardly  been  acted  upon  by  the  light.  If  we  take 
some  sensitized  paper  and  place  the  negative  over  it,  what 
happens  when  the  sun's  rays  are  allowed  to  act  upon  the 
paper*?  The  discolored  portions  of  the  negative  offer  some 
resistance  to  the  rays  and  thus  the  paper  is  but  slightly  dis- 
colored by  the  rays.  The  transparent  parts  of  the  nega- 
tive allow  the  rays  to  pass  readily.  The  result  is  that  the 
paper  is  quickly  discolored.  Thus  the  print  on  the  paper 
reverses  the  conditions  of  the  negative  and,  in  doing  so, 
shows  the  original  lights  and  shadows  of  the  object.  The 
white  face  of  the  man  is  white  in  the  print,  while  his  coat 
is  black.  Such  a  picture  is  properly  called  a  photograph  be- 
cause it  represents  a  sum-total  of  //'  °7tMmpressions  made  on 
a  sensitive  plate  or  paper. 

Strictly  speaking,  the  word  "X-ray  photography"  is  a 
contradiction  in  terms.  If  we  expose  a  sensitive  plate  to  the 
action  of  X-rays,  the  latter  will  penetrate  the  envelopes 
which  contain  the  plate  and  act  upon  the  silver  in  the  film 
just  like  sunlight.  If  the  whole  plate  is  thus  exposed,  the 
whole  plate  will  turn  black.  If  we  place  a  silver  dollar  on 
the  envelope  containing  the  plate,  the  space  covered  by  the 
coin  will  not  be  acted  upon  by  the  X-rays  because  they  are 
intercepted  by  the  metal.  The  negative  will  show  the  whole 
plate  black  except  the  part  which  was  covered  by  the  coin. 
If  we  place  on  the  envelope  containing  the  plate,  a  silver 
dollar,  a  piece  of  wood  about  the  size  and  thickness  of  the 
coin  and  a  piece  of  cloth  having  the  shape  and  size  of  the 
coin,  the  negative  would  be  black  except  in  three  places. 
The  coin  would  intercept  the  rays  completely,  the  wood 
slightly  and  the  cloth  hardly  at  all.  Thus  we  would  have 
no  discoloration,  a  slight  discoloration  and  a  hardly  per- 
ceptible discoloration  corresponding  to  the  places  covered 
by  the  dollar,  the  piece  of  wood  and  the  piece  of  cloth.  If 
we  place  a  square  block  of  wood,  one  inch  thick,  on  the 
envelope  containing  the  plate  and  put  the  dollar  on  top  of 


296  MODERX  PHYSIO-THERAPY. 

the  wood,  the  negative  would  show  a  square  space  of  slight 
discoloration  corresponding  to  the  space  occupied  by  the 
block  of  wood.  The  position  of  the  coin  would  be  marked 
by  a  circular  space  without  any  discoloration.  Thus,  the 
X-ray  negative  is  a  record  of  shadoi^s,  not  of  lights;  a  skia- 
graph, not  a  photograph.  The  depth  or  blackness  of  the 
shadow  on  the  negative  is  in  inverse  ratio  to  the  intercept- 
ing power  of  the  object,  /.  c.  the  greater  the  intercepting 
power  (opacity)  of  the  object,  the  slighter  the  shadow,  and 
vice  versa.  Thus,  the  X-ray  negative  of  a  hand  shows 
deeper  shadows  of  soft  tissues  than  of  bones. 

The  work  of  developing  an  exposed  plate  (making  a 
negative  out  of  it)  is  done  in  a  properly  equipped  dark- 
room. It  would  be  foreign  to  the  purposes  of  this  discussion 
to  give  technical  directions  concerning  the  equipment  neces- 
sary for  the  technical  part  of  this  work  and  the  modus 
operandi  to  be  followed  in  doing  the  work.  The  X-ray 
operator  who  is  ambitious  and  wishes  to  do  his  own  develop- 
ing, should  take  up  amateur-photography  and  in  this  way 
acquire  the  necessary  knowledge  and  skill  for  successful 
work  in  the  dark  room.  He  should  use  properly  prepared 
plates  of  suitable  size  (5x7,  8xio,  11x14).  The  medium 
size  is  the  most  generally  useful.  For  skiagraphs  of  the 
whole  chest  the  11x14  plates  are  the  most  available.  It  is 
difficult  to  overdevelop  an  X-ray  plate.  In  common 
photography  we  are  dealing  with  plates  that  have  been 
superficially  acted  upon  by  actinic  rays.  In  X-ray  work 
the  effect  has  penetrated  down  to  the  glass.  For  this  reason 
X-ray  plates  should  be  developed  slowly. 

Let  me  formulate  the  modus  operandi  by  way  of  a  few 
f imple  rules : 

1.  Keep  your  hands  clean; 

2.  Scrupulous  cleanliness  applied  to  the  trays  is  indis- 
pensable ; 

3.  Always  use  fresh  and  clean  solutions; 

4.  The  temperature  of  the  solution  should  not  be  under 
65°  F.  and  not  exceed  70°  F. ; 


X-RAY  DIAGNOSIS.  297 

5.  Do  not  think  of  developing  any  X-ray  picture  in  less 
than  ten  minutes ; 

6.  Negatives   will    not   last   unless   they   are    carefully 
washed  and  every  vestige  of  the  fixing  salt  is  removed. 

There  is  no  end  to  the  developing  agents  that  are  recom- 
mended and  used  by  different  authors  and  operators.  I 
have  used  two  developers  that  are  as  good  as,  if  not  better 
than,  any  other  developer  used.  The  first  was  suggested  by 
G.  G.  Burdick  and  is  as  follows : 

(A.) 

Ortol    15. 

Metol 15. 

Meta  bisulphite  of  potassium .75 

Bromide  of  potassium i. 

Distilled  water 1000. 

(B.) 

Distilled  water 1000. 

Sod.  sulphite   (c.  p.) 40. 

Sod.  carb.  (c.  p.) 60. 

Take  30  c.  c.  of  each  and  dilute  with  from  30  to  120 
c.  c.  of  water,  according  to  the  effect  desired.  The  less 
water,  the  more  contrast;  the  more  water,  the  more  detail. 

The  second  developer  is  recommended  by  Pizzigelli 
and  is  thoroughly  reliable : 

(A.) 

Glycin 30. 

Xatr.  Sulf 100. 

Natr.  Carb 20. 

Distilled  water 1000. 

(B.) 

Xatr.  Carb 100. 

Distilled  water 1000. 

(Mix  the  two  solutions  and  develop  in  the  mixture.) 

After  developing  the  plate,  the  process  of  handling  it 
(fixing,  washing,  drying)  does  not  differ  from  that  fol- 
lowed in  ordinary  photography. 


298  MODERN  PHYSIO-THERAPY. 

To  Interpret  An  X-ray  Picture. 

The  diagnostic  value  of  an  X-ray  picture  is  in  propor- 
tion to  the  interpreting  power  of  the  operator.  Thus  a  good 
X-ray  picture  may  possess  incalculable  diagnostic  value,  or 
it  may  be  valueless.  To  be  able  to  interpret  is  the  crown- 
ing effort  and  the  most  essential  part  of  radiographic  work. 

Diagnostic  X-ray  pictures  are  taken  for  the  purpose  of 
determining  I.  Change  in  normal  structure  (disease  of 
bone)  ;  2.  A  change  in  the  relation  of  normal  parts  (c.  g. 
fractures,  dislocations)  ;  3.  The  presence  and  location  of  an 
abnormal  structure  (e.  g.  a  tumor)  ;  4.  The  presence  of 
some  physiological  concretion  (e.  g.  stone  in  the  kidney)  ; 
5.  The  presence  and  location  of  a  foreign  substance  or  body 
(e.  g.  a  bullet,  a  needle). 

Examination  of  an  X-ray  picture  always  means  exam- 
ination of  the  negative  in  a  proper  light.  The  first  and  most 
essential  requirement  on  the  part  of  the  operator  is  famil- 
iarity with  the  appearance  of  negatives  of  normal  parts. 
By  experimental  radiographic  work  on  the  normal  body  he 
can  educate  his  eyes  and  his  judgment.  He  can  develop  his 
sense  of  proportion  and  relation  and,  above  all,  become 
familiar  with  the  meaning  of  shadows  and  the  many  fine 
nuances  of  the  latter. 

We  should  not  forget  that  an  X-ray  picture  is  always 
true  within  the  limits  of  the  physical  conditions  which  pro- 
duced it.  The  shape  and  relation  of  the  shadows  are  al- 
ways dependent  on  the  relative  position  of  the  tube  and 
the  object  to  the  plate.  The  relative  faintness  or  depth  of 
the  shadows  may  be  due  to  under-exposure,  over-exposure, 
faulty  vacuum  of  the  tube,  tinder-development  or  over-de- 
velopment. Inasmuch  as  these  physical  conditions  are  sub- 
ject to  never-ending  variations,  we  can  readily  see  how  the 
X-ray  picture  depends  on,  and  is  true  only  within,  the  limits 
established  by  these  physical  conditions.  Thus :  an  X-ray 
picture  will  not  show  a  foreign  body  unless  the  latter  is  ca- 
pable of  casting  a  shadow.  A  greenstick  fracture  may  not 
show  in  the  picture  if  the  bend  during  the  exposure  points 


X-RAY  DIAGNOSIS.  299 

towards  the  plate  or  toward  the  tube  and  in  this  way  pro- 
jects no  shadow  of  an  actual  angle  in  the  continuity  of  the 
bone.  An  over-exposed  plate  may  not  show  the  existence 
of  a  line  of  fracture.  The  picture  may  not  show  the  pres- 
ence of  a  foreign  body,  even  if  the  latter  is  as  large  as  a  set 
of  artificial  teeth.  In  Cleveland,  Ohio,  a  man  was  subjected 
to  an  oesophagotomy  because  the  X-ray  operator  stated  posi- 
tively that  the  teeth  were  lodged  in  the  oesophagus.  The 
man  died  and  the  teeth  were  found  under  his  bed.  In  an- 
other large  town  in  Ohio  a  man  who  was  supposed  to  have 
swallowed  a  set  of  teeth,  was  told  that  he  was  mistaken. 
Repeated  X-ray  examinations  showed  no  teeth.  The  man 
went 'to  Xew  York,  had  the  teeth  located  in  his  oesophagus 
by  X-rays,  was  operated  upon  and  recovered.  The  two 
instances  show  plainly  enough  that  the  success  of  X-ray 
work  depends  on  the  knowledge  and  skill  of  the  operator. 
The  X-rays  never  fail,  never  err,  never  bungle.  The  so- 
called  X-ray  mistakes  are  always  due  to  incompetency  of  an 
amateurish  operator. 

The  X-ra"y  picture  per  se  is  always — cceteris  paribus — a 
true  picture.  Its  interpretation,  however,  is  influenced  by 
variable  conditions.  From  the  very  nature  of  things,  there- 
fore, the  X-ray  picture  is  hardly  ever  more  than  one  of  the 
aids  to  diagnosis.  Its  province  is  to  corroborate,  to  con- 
firm, to  add  the  testimony  of  an  eye-witness  to  circumstan- 
tial evidence.  There  should  be  a  history  of  the  case  under 
consideration,  there  should  be  a  chain  of  symptomatic  evi- 
dence to  prepare  for  the  reasoning  involved  in  the  inter- 
pretation of  the  skiagraph.  As  a  link  in  the  chain  of  diag- 
nostic reasoning  the  skiagraph  is  invaluable,  especially  in 
the  practice  of  surgery  (fractures,  dislocations,  removal  of 
foreign  bodies).  If  the  diagnosis  involves  questions  of 
grave  import,  repeated  skiagraphic  examinations  should  be 
made. 

In  locating  a  foreign  body  the  part  containing  the  for- 
eign body  should  be  skiagraphed  in  the  line  of  its  perpen- 
dicular as  well,  as  its  horizontal  diameter.  A  skiagraph  of 


300  MODERN  PHYSIO-THERAPY. 

the  knee,  taken  from  above  downward,  the  posterior  surface 
resting  on  the  sensitive  plate,  may  show  a  bullet.  Diag- 
nostically  and  surgically  this  picture  is  valueless  because  it 
reveals  nothing  concerning  the  depth  at  which  the  foreign 
body  is  located.  A  picture  from  the  side  is  necessary  to  en- 
able the  surgeon  to  make  a  diagnosis  and  operate  accord- 
ingly. 

In  order  to  read  a  skiagraph  intelligently,  it  is  neces- 
sary to  be  familiar  with  the  peculiarities  of  X-ray  pictures. 
For  example : 

Skiagraph  an  elbow  after  putting  the  dorsal  side  of  the 
joint  on  the  sensitive  plate.  The  uninitiated  will  diagnose  a 
transverse  fracture  of  the  olecranon.  The  space  between 
the  humerus  and  ulna  makes  the  bony  tissue  of  the  ole- 
cranon behind  it  appear  so  faint  that  the  line  of  faint- 
shadow  corresponding  to  the  space  between  the  bones  looks 
strikingly  like  a  line  of  fracture.  Another  example  te  the 
shoulder- joint.  The  space  between  the  end  of  the  clavicle 
and  the  acromiom  misleads  the  uninitiated  in  nearly  every 
instance.  He  invariably  diagnoses  a  fracture  of  the  clav- 
icle. I  know  of  one  instance  in  which  the  diagnosis  of  kid- 
ney-stone was  made.  The  "stone"  was  one  of  the  spinous 
processes,  the  extremity  of  which  happened  to  cast  an 
unusually  deep  shadow.  In  children  mistakes  are  often  made 
by  operators  who  forget  that  ossification  is  not  complete, 
and  that  allowance  must  be  made  for  this  fact.  Many  ex- 
amples of  the  whims  and  peculiarities  of  X-ray  pictures 
could  be  cited. 

Many  mistakes  in  interpretation  are  made  through  the 
purely  photographic  features  of  a  picture.  I  remember  an 
instance  in  which  the  nude  knee  of  a  physician  was  skia- 
graphed  for  purposes  of  demonstration.  The  picture 
showed  faint  lines  running  irregularly  around  the  joint. 
These  lines  looked  for  all  the  world  like  folds  of  garments. 
Vet  every  one  knew  that  the  knee  had  been  exposed  nude. 
No  one  seemed  to  be  able  to  account  for  the  appearance  of 
these  faint  lines.  The  solution  was  simple.  In  immersing 


X-RAY  DIAGNOSIS.  301 

the  plate  in  the  developing  fluid  the  latter  did  not  flow 
rapidly  and  evenly  over  the  entire  plate,  but  covered  only  a 
part  of  the  plate  causing  a  line  to  appear  where  the  fluid 
had  halted  for  a  fraction  of  a  second.  Lack  of  cleanliness 
frequently  leads  to  serious  blunders. 

The  X-ray  picture  as  a  positive  means  of  diagnosis 
sh6uld  be  furnished  by  a  radiographer  who  is  equally  famil- 
iar with  the  technical  part  of  X-ray  exposures  and  with  the 
technique  of  developing  plates.  Nothing  has  injured  the 
cause  of  X-ray  work  more  than  the  bulk  of  poor  radio- 
graphic  work  which  is  done  by  unskilled  and  inexperienced 
amateur-radiographers. 

Stereo-Skiagraphy. 

Stereo-skiagraphy  is  the  most  recent  and  promises  to  be 
'the  most  valuable  achievement  of  radiography.  Its  object  is 
to  make  pictures  which  have  the  distance,  perspective  and 
plasticity  of  the  real  object.  It  is  analogous  to  stereoscopy. 
Its  technique  has  been  well  described  by  M.  K.  Kassabian, 
of  Philadelphia,  who  summarizes  the  subject  as  follows: 
The  ordinary  photographs  and  images  look  flat,  while 
stereoscopic  pictures  which  are  made  by  two  lenses,  each 
being  two  and  one-half  to  two  and  three-quarters  inches 
from  each  other  (corresponding  to  the  distance  between  the 
two  pupils  of  the  eyes)  will  be  impressed  on  the  retina  as  one 
picture  thus  giving  a  perspective  view.  The  technique  of 
stereo-skiagraphy  consists  of  taking  two  separate  skiagraphs 
of  the  same  part,  on  two  different  sensitive  plates,  without 
changing  the  position  of  the  parts,  but  displacing  the  posi- 
tion of  the  Crookes  tube  two  and  one-half  to  two  and  three- 
quarters  inches  (6  cm.),  corresponding  to  the  distance  of 
the  pupils  of  the  eyes. 

In  order  to  produce  two  negatives  of  equal  density  the 
degree  of  penetration  of  the  rays  should  be  as  nearly  alike 
as  possible.  There  are  no  two  tubes  that  have  the  same  de- 
gree of  vacuum,  and  the  same  tube  changes  its  vacuum  dur- 
ing exposure.  The  operator  should  judge  the  time  of  ex- 


302 


MODERN  PHYSIO-THERAPY. 


posure  of  the  second  plate  from  experience.  A  self-regulat- 
ing tube  is  preferable  in  all  cases.  It  is  proper  to  give  a 
little  longer  time  for  the  second  exposure  than  the  first  be- 
cause the  tube  runs  down  a  little  and  the  penetration  les- 
sens. Short  exposures  are  most  desirable. 

In  order  to  have  two  negatives  of  equal  density,  the 


FIGURE    10. 
DIAGRAM  ILLUSTRATING  THE  PRINCIPLE  OF  STEREO-SKIAGRAPHY. 

process  of  development  should  be  carried  on  with  great  care. 
The  developers  should  be  the  same  for  both  according  to  the 
degree  of  density  desired.  Soft  negatives  are  preferable. 

The  advantages  of  stereo-skiagraphy  are  obvious.  In 
both  long  and  short  bones  the  trabeculae  are  seen,  and  in 
the  long  bones  we  may  see  the  arrangement  of  the  lamellae 
in  the  shafts  and  in  the  cancellous  tissue.  The  spiral  ar- 
rangement of  the  lamellae  is  distinctly  shown,  especially  in 


X-RAY  DIAGNOSIS.  303 

the  humerus  and  femur,  as  also  is  the  change  in  their  direc- 
tion near  the  articular  surfaces,  bringing  them  into  columns 
perpendicular  to  the  surface  of  the  pressure.  In  examining 
the  dry  skull,  the  grooves  for  the  meningeal  arteries  are 
seen,  the  concave  appearance  of  the  skull  processes,  the 
frontal  sinuses,  the  antra  of  Highmore,  the  turbinated  bones, 
etc.  It  is  very  interesting  to  view  these  results  in  the  living 
subject  as  well  as  in  the  skeleton.  In  studying  the  mechan- 
ism of  the  joints,  these  pictures  give  a  perspective  view  of 
the  relations  of  the  articular  surfaces  of  the  bones  and  the 
actual  depth,  and  the  relation  of  the  processes  to  the  ob- 
server. Arteries,  veins,  bronchi,  and  excretory  ducts,  when 
injected  with  opaque  materials,  such  as  lead  or  mercury, 
show  their  exact  relations  (their  depth)  to  the  bones,  the 
muscles,  etc.  Stereo-skiagraphy  is,  without  a  doubt,  the 
most  satisfactory  method  of  locating  foreign  bodies.  The 
same  statement  holds  good  in  regard  to  fractures,  the 
method  procuring  definite  views  of  injuries,  namely  the  ex- 
act location  of  the  fragments,  the  amount  of  over-lapping, 
the  separation,  the  degree  of  apposition  in  deformities,  etc. 
The  ordinary  skiagraph  does  not  show  the  variety  and  char- 
acter of  a  dislocation.  The  stereo-skiagraph,  however,  over- 
comes this  difficulty,  producing  a  clear  and  definite  view  of 
the  existing  condition,  so  as  to  differentiate  between  an  an- 
terior and  a  posterior  dislocation.  In  viewing  the  thorax 
we  may  see  either  an  anterior  or  a  posterior  aspect,  depend- 
ing on  the  position  of  the  plates.  The  heart,  its  position ; 
the  aorta,  its  relation  to  the  vertebral  column ;  the  beautiful 
cage-appearance  of  the  thorax,  the  location  of  a  cavity  or 
consolidation,  etc.,  are  interesting  from  a  practical  as  well1 
as  from  a  scientific  standpoint. 

X-ray  Accessories. 

Walter's  Skiameter. — In  order  to  be  able  to  determine 
the  vacuity  (hardness,  softness)  of  a  tube,  most  operators 
examine  the  shadows  of  their  hand  through  a  fluoroscope. 
This  is  a  thoroughly  bad  habit  on  account  of  the  too  fre- 


304 


MODERN  PHYSIO-THERAPY. 


quent  exposure  of  the  hand  to  the  rays.  Dr.  B.  Walter,  of 
Hamburg,  has  devised  a  little  instrument  which  reveals  the 
vacuity  of  the  tube  in  a  definite  and  reliable  manner.  The 
base  of  the  instrument  consists  of  eight  small  pieces  of  tin- 
foil of  different  thickness,  which  are  covered  with  a  bario- 
platinum  screen.  By  holding  the  base  of  the  instrument  up 
to  an  excited  X-ray  tube,  the  bario-platinum  will  iluoresce 
in  proportion  to  the  amount  of  penetrating  power  which 
the  rays  possess.  If  the  tube  is  soft,  with  but  scant  pene- 


WALTER'S  SKIAMETER. 

trating  power  of  the  rays,  there  would  be  no  visible  fluon-s- 
cence  of  the  screen,  except  where  it  covers  the  thinnest  piece 
of  tin-foil.  Over  the  remaining  seven  spaces  the  tin-foil 
would  be  too  thick.  The  rays  would  be  intercepted  and  no 
fluorescence  visible.  If  the  tube  is  a  trifle  harder,  two 
spaces  might  be  seen  to  fluoresce,  or  three  or  four,  depend- 
ing on  the  penetrating  power  of  the  rays  and  the  corre- 
sponding thickness  of  the  tin-foil.  Thus  a  very  hard  tube 
would  light  up  seven  or  even  eight  spaces.  The  instrument 
is  called  a  skiameter  and  is  indeed  a  very  useful  addition  to 
an  X-ray  equipment. 


X-RAY  DIAGNOSIS.  305 

The  X-ray  Table. — A  solid  wooden  table,  6^2x2  feet, 
answers  the  purpose.  It  ought  to  be  fenestrated  at  two 
places,  one  fenestra  to  correspond  to  the  location  of  a  pa- 
tient's chest,  the  other  to  his  knees.  The  chest-fenestra 
should  be  eight  inches  square,  the  other  one  six  inches 
square.  The  corresponding  shutters  should  drop  out,  not 
lift  out.  When  they  are  in  position  they  should  be  secured 
from  below  so  that  there  may  be  no  unevenness  on  the  sur- 
face of  the  table.  They  should  be  arranged  so  that  they  can 
be  taken  out  altogether.  Hinges  are  not  desirable.  The 
object  of  the  fenestra  is  to  enable  the  operator  to  make  a 
fluoroscopic  study  of  a  part  with  the  patient  on  the  table 
and  the  tube  secured  below  the  table.  The  operator  looks 
down  at  the  part  through  the  fluoroscope.  The  fenestra 
should  be  closed  unless  it  is  being  used. 

X-ray  Tubes. — Every  operator  should  have  at  least  three 
or  four  good  tubes.  For  radiographic  work  he  should  have 
a  water-cooling  or  a  heavy  anode  tube.  For  X-ray  treat- 
ments any  kind  of  a  tube  will  answer.  The  static  machine 
will  meet  the- requirements  of  radio-therapy,  but  only  in  a 
limited  sense  those  of  radiographic  work,  the  statements  of 
some  operators  notwithstanding.  A  good-sized  coil  is  in- 
dispensable if  good  radiographic  work  is  to  be  done.  Special 
therapeutic  tubes  (Caldwell's,  etc.)  are  not  of  great  prac- 
tical value. 

X-ray  Stand. — It  should  be  made  of  heavy  wood  and  be 
solid.  It  should  have  a  square,  adjustable,  lead-lined  shield- 
attachment  (18x12  inches).  The  tube  is  mounted  about  six 
inches  above  a  perforation  (four  inch  diameter)  which 
represents  the  center  of  the  shield.  The  latter,  when  in  its 
proper  position  is  approximately  parallel  to  the  table  upon 
which  the  patient  lies.  Most  X-ray  treatments  are  best 
given  with  the  patient  on  the  table.  By  placing  pieces  of 
sheet-lead  on  the  upper  surface  of  the  shield,  the  central 
opening  can  be  given  any  size  or  shape  to  correspond  to 
the  surface  to  be  treated.  In  treating  the  face,  it  is  a  good 
rule  to  cover  the  eyes  separately.  A  shield  can  be  made  by 


306 


MODERN  PHYSIO-THERAPY. 


any  carpenter  and  attached  to  any  solid  X-ray  stand.  In 
radiographic  work  it  may  be  used  as  a  diaphragm  to  inter- 
cept tangential  radiations. 

Lead. — Lead  is  the  cheapest  and  most  useful  metal  to 
intercept  the  X-rays.     The  operator  should  keep  a  dozen  or 


X-RAY  DERMATITIS. 


more  pieces  of  sheet-lead  on  hand.     One  of  the  essential 
points  of  X-ray  work  is  to  cover  sound  parts  carefully. 

X-ray  Camera. — Ever)'  operator  should  provide  him- 
self with  some  device  to  intercept  tangential  radiations. 
Even  if  he  does  not  wish  to  invest  in  cue  or  other  of  the 


X-R.\Y  DIAGNOSIS. 


307 


more  or  less  expensive  devices  which  are  on  the  market,  he 
can  improvise  an  apparatus  of  this  kind  in  a  primitive  and 
yet  effective  manner.  Suggestions  as  to  the  manner  of 
doing  it  have  been  given  previously.  The  X-ray  shield  de- 
scribed above  may  be  used  for  this  purpose  to  good  ad- 
vantage. 

Dangers  of  X-ray  Work. 

X-ray  Dermatitis,  etc. — The  occurrence  of  any  degree 
of  an  X-ray  "burn"  in  a  patient  (molecular  destruction  of 


CARL  BECK'S  TUBULAR  DIAPHRAGM. 

sound  tissue)  is  almost  invariably  due  to  faulty  technique. 
The  proper  use  of  sheet-lead  and  a  reasonable  amount  of 
knowledge  of  the  Roentgen  tube  should  prevent  it  under  all 
circumstances.  The  cases  of  X-ray  idiosyncrasy  (unusual 
susceptibility  to  X-rays)  are  very  rare.  The  subject  of 
X-ray  "burns"  is  considered  more  at  length  under  the  head 
of  "RADIO-THERAPY/'  Local  reaction  should  never  pass  be- 
yond the  point  of  pigmentation. 

In  looking  after  the  comfort  and  safety  of  his  patient, 
the  operator  should  not  forget  that  his  own  body  is  liable 


308  MODERN  PHYSIO-THERAPY. 

to  be  injured  by  constant  exposure  to  the  X-rays.  He  should 
avoid  unnecessary  exposure  and  should  protect  his  body  as 
effectively  as  is  possible,  while  he  is  compelled  to  expose 
himself.  Recently  a  complete  line  of  very  serviceable 
opaque  gloves,  aprons,  shields,  masks,  etc.,  has  been  placed 
on  the  market.  A  very  simple  and  effective  plan  is  to  put  a 
substantial  stationary  screen  in  one  corner  of  the  room. 
The  screen  should  be  lead-lined  and  can  be  suitably  covered 
or  draped.  A  mirror  can  be  placed  behind  the  screen,  en- 
abling the  operator  to  watch  the  patient  and  the  details  of 
the  treatment  through  the  mirror. 

Among  the  disastrous  results  which  may  follow  con- 
tinued exposure  to  the  Roentgen  rays  are : 

Chronic  inflammation  of  the  skin,  attended  with  great 
pain  and  intolerable  itching; 

Sloughing  (gangrene)  of  the  skin  and  subcutaneous 
tissues.  This  condition  is  not  infrequently  progressive, 
gradually  involving  more  and  more  of  the  healthy  tissue. 
In  some  cases  it  has  led  to  complete  destruction  of  the  soft 
parts,  necessitating  amputation  of  one  or  more  fingers  of 
the  hands  and  even  of  both  arms ; 

Loss  of  hair  (eyebrows,  scalp)  and  deformity  or  total 
loss  of  nails ; 

A  red,  glossy  appearance  of  the  skin  on  both  hands ; 

A  wrinkled  and  shriveled  appearance  of  the  hands ; 

More  or  less  acute  or  chronic  conjunctivitis,  sometimes 
followed  by  granulated  lids ; 

Impairment  of  sight ; 

A  tendency  towards  malformations  and  growths  on  the 
exposed  parts ; 

Pruritus  of  the  exposed  portions  of  the  skin ; 

A  peculiar  form  of  urticaria  on  the  back  of  the  hand 
which  is  badly  aggravated  by  heat,  actinic  rays  and  gastric 
influences ; 

A  general  systemic  depression  characterized  by  a  waxy 
skin,  dull  expression  of  the  eyes,  sunken  features,  impair- 
ment of  the  sweat  function,  mental  hebetude,  melancholia, 


X-R.\Y  DI/.GXOSIS. 


309 


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310 


MODERN  PHYSIO-THERAPY. 


illusions,  sluggishness  of  the  circulation  and  a  general  de- 
cline (two  cases  of  this  kind  have  been  seen  and  treated  by 
me  during  the  past  two  years)  ; 

Sterility  due  to  impairment  and  death  of  the  sperma- 
tozoa. 


SKIAGRAPH  OF  UNPROTECTED    HAND    EXPOSED  TO  X-RAYS, 

Explosion  of  an  X-ray  Tube. — X-ray  tubes  do  not  really 
explode,  but  collapse  with  tremendous  violence.  The  noise 
is  deafening  and  the  force  with  which  the  glass-tube  is  re- 
duced to  dust  is  terrific.  The  glass-dust  is  scattered  in  all 
directions  with  great  violence.  Explosions  of  tubes  do  not 
occur  often.  I  witnessed  an  occurrence  of  this  kind  a  year 


X-R.\Y  DIAGNOSIS. 


311 


or  two  ago.  Fortunately  no  one  was  injured.  It  seems  that 
tube-explosions  are  due  to  changes  in  the  temperature  caus- 
ing contraction  or  expansion  oi  the  glass. 

Explosion  of  an  X-ray  Coil. — On  February  22,  1904,  9 
A.  M.,  I  was  about  to  treat  a  case  of  epithelioma  of  the  lip. 


SKIAGRAPH  OF   HAND  PROTECTED 
BY  AN  X-RAY  GLOVE. 

The  patient  and  the  tube  were  in  position.  The  moment  the 
current  was  turned  on,  the  top  of  the  Scheidel  coil  which  I 
was  using  was  blown  out  with  great  force  amid  clouds  of 
smoke  and  a  deafening  noise.  The  explosion  caused 
a  great  deal  of  damage  in  the  room,  although  the 
patient  and  myself  escaped  without  injury.  I  have  no  com- 


312  MODERN  PHYSIO-THERAPY. 

ment  to  make  beyond  demonstrating  the  possibility  of  an  oc- 
currence of  this  kind. 

In  conclusion  let  me  add  a  word  or  two  of  advice  to 
those  who  make  a  specialty  of  radiographic  work.  If  they 
wish  to  remain  true  to  the  interests  of  the  profession  and  to 
the  interests  of  radiographic  work,  it  is  a  good  idea  to  be 
guided  by  three  distinct  and  immutable  rules  of  action,  to 
wit : 

1.  Never  do  radiographic  work  unless  it  is  to  benefit 
some  physician  and  through  him  some  unfortunate  patient. 
If  a  "layman  wants  radiographic  work  done,  he  should  be 
your  or  some  other  physician's  patient,  and  the  request  come 
from  the  physician.    If  a  patient  asks  for  radiographic  work 
without  his  physician's  knowledge  and  consent,  be  careful. 
If  the  request  comes  from  a  lawyer,  be  doubly  careful. 

2.  Give  one  or  two  copies  of  the  X-ray  picture  to  the 
physician  for  whom  the  X-ray  work  was  done.     If  the  pa- 
tient is  to  get  a  picture,  let  his  physician  give  it  to  him. 
Your  dealings  are  with  the  doctor,  never  with  the  patient. 
Never  give  up  a  negative  to  any  person  at  any  time  or  un- 
der any  circumstances. 

3.  Never  pretend  to  interpret  an  X-ray  picture  to  any 
patient.     If  the  doctor  asks  for  your  opinion,  give  it.     At 
all  times  remember  that  the  X-ray  expert  should  not  be  ex- 
pected to  give  an  expert  surgical  opinion  unless  he  is  called 
upon  to  do  so.    In  this  case  he  ought  to  get  an  additional  fee. 

By  acting  upon  the  suggestions  given,  the  X-ray  oper- 
ator will  be  loyal  to  his  colleagues,  will  be  legitimate  in  his 
radiographic  work,  and — last  but  not  least — he  will  keep 
out  of  much  unnecessary  trouble. 


PRINCIPLES  AND  PRACTICE  OF  X-RAY  THERAPY.    313 


CHAPTER  XL 

THE  PRINCIPLES  AND  PRACTICE  OF  X-RAY 
THERAPY. 

THE  average  physician  looks  upon  the  therapeutic  use 
of  the  Roentgen  rays  as  an  interesting  experiment  which 
at  one  time  promised  a  great  deal,  but  has  accomplished 
comparatively  little.  That  this  "experiment"  possesses 
positive  therapeutic  value  with  well-defined  clinical  indi- 
cations is  denied  by  the  bulk  of  the  profession,  while  even 
radio-therapeutists  of  experience  hesitate  to  make  an  uncon- 
ditional statement  of  this  kind  on  behalf  of  the  mysterious 
X-ray.  And  yet  the  Roentgen  rays  as  a  therapeutic  agent 
do  occupy  an  established  position.  The  disappointments 
which  have  followed  in  the  wake  of  X-ray  therapeutic  work 
are  attributable  to  one  factor:  misuse  of  a  valuable  thera- 
peutic agent  in  the  hands  of  misinformed  or  unskilled  opera- 
tors. The  popularization  of  the  static  machine  has  placed 
the  Roentgen  rays  in  the  hands  of  every  physician  who 
cares  to  invest  in  a  machine.  His  equipment  includes  an 
X-ray  tube.  He  is  told  how  to  attach  the  tube  properly 
and  then  proceeds  to  bungle  along,  treating  one  case  after 
another  without  diagnostic  consideration  for  his  case  and 
utterly  disregarding  the  physical  conditions  of  his  tube. 
Thus  he  adds  to  the  bulk  of  X-ray  work  which  is  clone 
throughout  the  country.  After  his  first  optimistic  ardor  has 
cooled  off  he  neglects  the  work  and  joins  the  vast  army  of 
the  skeptics  who  smile  at  the  claims  which  are  made  on  be- 
half of  radio-therapeutic  work.  Adding  to  the  skepticism  of 
the  bulk  of  the  profession  the  untold  injury  which  yellow 
journalism  has  inflicted  upon  this  modern  branch  of  thera- 


314  MODERN  PHYSIO-THERAPY. 

peutic  work,  we  can  readily  understand  the  unjust  position 
of  X-ray  therapy  and  the  reasons  therefor.  Yet,  it  is  an 
undeniable  and  easily  demonstrated  fact  that  the  X-ray  is 
an  established  therapeutic  agent,  with  a  clearly  denned 
sphere  of  usefulness.  It  is  not  a  panacea  nor  is  it  a  specific. 
Like  all  other  therapeutic  agents  in  medicine  and  surgery 
it  meets  certain  conditions  within  certain  limitations.  The 
personal  equation  of  the  patient's  physical  make-up  is  al- 
ways a  factor  which  can  not  be  defined  with  accurate  pre- 
cision. It  is  always  the  unknown  quantity  in  any  thera- 
peutic problem  makes  the  concrete  application  of  any  thera- 
peutic agent  an  art,  however  scientific  the  abstract  physio- 
logical activity  of  the  given  therapeutic  agent  may  be.  In 
this  sense  X-ray  therapy  is  on  precisely  the  same  level  with 
the  bulk  of  therapeutic  agents  at  our  command.  The  suc- 
cess of  X-ray  therapeutic  work  depends  on  an  accurate 
knowledge  of  the  physical  phenomena  which  are  included 
in  the  radio-activity  of  an  excited  X-ray  tube.  Without 
some  knowledge  of  the  physics  of  the  X-ray  tube  the  thera- 
peutic use  of  the  Roentgen  rays  is  nothing  but  haphazard 
guess-work. 

The  Physics  of  an  Excited  X-ray  Tube. 
What  happens  when  the  converging  beam  of  cathodal 
light  is  concentrated  in  the  anodal  focus  and  unites  with  the 
electro-positive  element?  The  appearance  of  the  illumi- 
nated X-ray  tube  is  familiar.  One  hemisphere  is  aglow  with 
a  greenish  light  while  the  hemisphere  behind  the  anodal 
(anti-cathodal)  disc  remains  dark.  These  phenomena  were 
known  long  before  the  time  of  Roentgen  (Crookes,  Geiss- 
ler).  Roentgen's  discovery  concerns  a  force-modality  of 
some  sort  originating  on  the  external  surface  of  the  excited 
tube.  Roentgen  could  not  account  for  the  evidences  of  this 
mysterious  radiating  energy  and  designated  them,  there- 
fore, as  the  unknown-quantity  rays  or  X-rays.  They  are  the 
product  of  an  induction-process  of  some  sort,  or,  to  speak 
with  more  accuracy,  it  seems  that  the  phenomena  which 


PRINCIPLES  AND  PRACTICE  OF  X-RAY  THERAPY.    315 

takes  place  in  the  excited  tube  induce  a  series  of  correlative 
force-manifestations  outside  of  the  tube.  I  say  "correla- 
tive" because  the  X-ray  phenomenon  depends  in  all  its 
physical  characteristics  on  the  ever-varying  physical  con- 
ditions which  prevail  in  the  interior  of  the  tube.  The  term 
"X-ray,"  then,  is  rather  a  generic  term  covering  an  almost 
endless  variety  of  manifestations  and  degrees  of  intensity  of 
this  mysterious  induced  force. 

The  most  important  physical  element  of  the  tube  is  the 
degree  of  exhaustion.  Upon  it  depends  the  relative  in- 
tensity of  the  phenomena  induced  on  the  outside  of  the 
tube.  From  the  lowest  degree  of  exhaustion  to  the  highest 
vacuity  compatible  with  the  safety  of  the  glass  tube,  there 
is  a  constantly  changing  activity  on  the  outside  of  the  tube. 
As  the  degree  of  exhaustion  becomes  higher,  the  X-ray- 
waves  seem  to  travel  with  greater  velocity  and  penetrating 
power.  The  wave-length  diminishes  in  inverse  ratio  to  the 
internal  resistance  of  the  tube,  while  the  number  of  undula- 
tions, measured  in  units  of  space-dimension  as  well  as  of 
time,  increases.  As  the  internal  resistance  of  the  tube  de- 
creases, the  wave-length  of  the  force-manifestations  on  the 
outside  of  the  tube  increases,  while  the  number  of  undula- 
tions per  inch  or  per  second  is  gradually  diminished.  In 
making  these  statements,  we  are  reasoning  from  premises 
which  are  furnished  by  the  vibratory  theory  of  force-mani- 
festation, now  generally  accepted  by  physicists,  and  by  the 
experimental  evidence  adduced  by  carefvil  observers. 

The  computation  of  the  length  and  velocity  of  luminous 
vibrations  of  the  different  parts  of  the  solar  spectrum  is  not 
altogether  a  theoretical  calculation.  Wave-speed  and  wave- 
length, while  they  are  results  of  abstraction  and  deduction, 
furnish  the  only  plausible  explanation  of  the  various 
phenomena  of  light,  light-transmission,  and,  in  fact,  of  all 
manifestations  to  force  by  which  matter  proclaims  its  ex- 
istence in  nature.  The  X-rays,  being  one  mode  of  energy, 
must  have  their  undulations  and  their  wave-length  analo- 
gous to  those  of  other  forms  of  force-manifestation.  When 


316  MODERN  PHYSIO-THERAPY. 

the  vacuum  of  the  tube  is  too  low  for  X-ray  production, 
there  is,  nevertheless,  an  abundance  of  chemical  light-en- 
ergy. These  radiations  are  located  in  the  spectral  field  be- 
yond the  violet  end  and,  therefore,  classified  as  ultra-violet 
ladiations.  This  is  a  distinctly  generic  designation,  because 
it  refers  to  perhaps  thousands  of  different  forms  of  radia- 
tion, whose  wave-speed  is  greater  and  wave-length  less  than 
those  of  the  rays  in  the  violet  field.  The  length  of  a  ray 
from  the  violet  field  is  approximately  given  as  the  0.0000167 
of  an  inch,  while  the  number  of  undulations  per  second  is 
about  727,000,000,000,000  (Eisenlohr,  Silliman).  The  ra- 
diations from  the  ultra-violet  field  diminish  in  wave-length 
as  they  get  further  away  from  the  (visible)  violet  field, 
while  the  vibrations  increase  in  number.  All  these  vibra- 
tions belong  to  the  invisible  chemical  field  of  the  spectrum. 

That  the  force-manifestations  which  take  place  on  the 
outside  of  an  excited  X-ray  tube  generically  include  an  in- 
definite variety  of  force-modalities  representing  different 
speed  and  length  of  oscillation  and  undulation  of  ethereal 
molecules,  is  plain.  That  some  of  these  modalities  are  char- 
acterized by  relatively  slow  oscillation  and  comparatively 
long  waves  is  proven  by  the  presence  of  heat-rays,  while, 
strangely  enough,  spectroscopic  analysis  of  cathodal  rays 
shows  a  scarcity  of  luminous  rays,  but  an  abundance  of 
chemical  rays.  It  seems  justifiable,  therefore,  to  consider 
the  Roentgen  rays  a  generic  aggregation  of  force-modali- 
ties rather  than  one  specific  kind  of  radiation. 

The  question  of  refrangibility  is  of  some  importance  in 
solving  the  problem  of  the  physics  of  the  X-rays.  The  least 
refrangible  rays  are  the  red.  The  refrangibility  increases 
toward  the  violet  end  of  the  spectrum.  It  has  been  stated 
that  a  certain  quantity  of  ultra-violet  radiations  comes  from 
the  inside  of  the  X-ray  tube  and  penetrates  the  glass.  Con- 
sidering their  extreme  refrangibility,  it  would  not  be  diffi- 
cult to  imagine  these  radiations  to  be  refracted  by  the 
curved  surface  of  the  tube,  which  in  this  case  acts  like  a 
prism.  This  seems  to  offer  a  plausible  explanation  for  the 


PRINCIPLES  AND  PRACTICE  OF  X-RAY  THERAPY.    317 

tangential  waves  which  Walter  has  described  under  the 
name  of  "secondary  radiations."  They  are  unquestionably 
refracted  ultra-violet  radiations  from  within  the  tube. 

That  the  X-rays  belong  under  the  generic  head  of  ultra- 
violet radiations  is  further  shown  by  their  action  on  sensi- 
tive photographic  plates.  They  affect  photographic  plates 
like  actinic  rays.  The  greater  penetrating  power  of  the 
Roentgen  rays  is  due  to  the  speed  and  intensity  of  trans- 
mission. The  ordinary  chemical  solar  or  electric  arc-light 
does  not  affect  the  silver  throughout  the  entire  thickness 
of  the  film,  but  only  the  superficial  layers  of  the  film.  The 
X-rays  penetrate  the  film  down  to  the  glass,.  In  this  way 
the  different  manner  in  which  a  sensitive  plate  acts  after 
an  X-ray  exposure,  or  after  exposure  to  sunlight,  is  easily 
explained.  It  is  almost  impossible  to  over-develop  an  ex- 
posed X-ray  plate,  because  the  whole  film  down  to  the  glass 
has  been  acted  upon. 

The  intercepting  power  of  glass  is  another  feature  which 
suggests  the  similarity  of  the  two  forms  of  radiation.  Fin- 
sen  discarded  glass  because  of  its  absorptive  action.  He 
used  rock-crystal  in  its  place.  It  is  peculiar  that  glass  will 
cast  a  decidedly  deeper  shadow  on  the  fluoroscopic  screen 
than  rock-crystal.  The  latter,  if  of  good,  pure  quality, 
seems  to  offer  absolutely  no  obstacle  to  the  Roentgen  rays. 

The  therapeutic  effects  seem  to  furnish  the  best  evi- 
dence. The  destructive  action  of  the  X-rays  results  in 
necrosis  due  to  impairment  of  the  trophic  nerves,  which 
causes  an  obliterative  endarteritis.  The  so-called  X-ray 
burn  is  distinctly  a  necrotic  process.  The  same  effect,  on  a 
smaller  scale  and  more  superficially,  is  noticed  after  forced 
application  of  concentrated  actinic  rays.  Beginning  with 
the  primary  erythema,  the  subsequent  dermatitis  and  the  re- 
sulting deposit  of  pigment,  the  effects  of  the  two  forms  of 
radiation  are  certainly  only  different  in  degree  of  intensity 
?nd  in  depth  of  penetration.  I  have  seen  a  typical  derma- 
titis and  superficial  necrosis  follow  prolonged  actinic  ex- 
posures, the  gross  features  and  microscopic  appearances 


318  MODERN  Pnvsio-'liii-R APV. 

not  differing  in  the  least  from  analogous  effects  produced 
by  the  X-rays.  The  relative  degree  of  germicidal  action  of 
the  two  forms  of  radiation  is  unquestionably  an  argument  in 
support  of  the  views  expressed.  The  ultra-violet  rays  are 
distinctly  germicidal ;  so  are  the  radiations  from  a  low  tube. 
The  higher  the  internal  tension  of  the  tube,  the  slighter  is 
the  effect  on  germ-life.  This  fact  has  established  the  thera- 
peutic value  of  the  soft  tube  and,  at  the  same  time,  ex- 
plains the  futility  of  the  therapeutic  efforts  made  with  the 
higher-tension  tubes.  No  one  thinks  nowadays  of  X-ray 
therapy  in  connection  with  deep-seated  lesions.  The  harder 
the  tube,  the  more  meager  the  amount  of  energy  generated, 
the  more  rapid  the  penetration  and  diffusion.  The  softer  the 
tube,  the  greater  the  output  of  energy,  the  more  concen- 
trated and  powerful  the  effect.  The  softer  the  tube,  the 
more  striking  is  the  resemblance  between  the  action  of  the 
X-rays  and  the  effect  produced  by  concentrated  chemical 
rays. 

My  object  in  dilating  upon  these  physical  characteristics 
of  the  X-rays  is  plain.  I  desire  to  demonstrate  that  they 
are  true  ultra-violet  radiations,  and  thus  find  a  solid  scien- 
tific basis  for  the  therapeutic  indications  of  X-ray  work. 
We  are  fairly  well  acquainted  with  the  physical  character 
and  the  physiological  activity  of  actinic  rays.  Finsen's  re- 
searches have  given  us  much  information  concerning  this 
subject.  If  the  X-rays  are  generically  ultra-violet  radia- 
tions, we  are  no  longer  at  sea  in  regard  to  their  therapeutic 
possibilities.  One  additional  point  indicates  the  strong 
generic  relationship  between  the  two  force-modalities.  Fin- 
sen  has  shown  that  the  deposit  of  pigment  in  the  skin  is 
Nature's  way  of  protecting  its  organism  against  the  de- 
structive action  of  the  actinic  rays.  Pigment  absorbs  these 
rays.  Experience  has  taught  me  that  the  skin  of  the  negro 
offers  more  resistance  to  the  X-rays  than  non-pigmented 
cuticle.  It  is  harder  to  get  a  good  skiagraph  of  a  negro's 
than  of  a  white  man's  spine.  The  large  surface  exposed 


PRINCIPLES  AND  PRACTICE  OF  X-RAY  THERAPY.    319 

( abdomen  and  back )  contains  so  much  pigment  that  a  good 
deal  of  X-ray  energy  is  lost,  being  absorbed  by  the  pigment. 

The  pigment  in  the  red  blood-cells  absorbs  X-rays.  Thus 
we  can  explain  why  it  is  comparatively  easy  to  skiagraph  a 
bloodless  part  (hand  after  an  Esmarch  bandage  has  been 
applied  to  the  arm).  Radiographers  know  that  anemic  per- 
sons make  excellent  subjects  for  radiographic  work. 

The  practical  conclusions  from  these  theoretical  pre- 
mises may  be  summarized  thus : 

1.  The  X-ray  and  the  actinic  and  ultra-violet  rays  of 
the  solar  spectrum  belong  under  the  same  generic  head ; 

2.  The  difference  between  the  two  force-modalities  is 
the    greater  speed  of    oscillation  and    the  shorter  wave- 
length of  the  Roentgen  ray  ; 

3.  The  penetrating  power  of  the  X-rays  is  in  direct  pro- 
portion to  the  pressure  of  the  vacuum  in  the  tube ; 

4.  Penetrating  power  and  quantity  of  energy  are  in  in- 
verse ratio  to  each  other ; 

5.  Like  all  induced  forms  of  energy  the  X-rays  lose  their 
volume  in  proportion  to  the  distance  from  the  source  of  in- 
duction, i.  e.  the  tube ; 

6.  The  X-rays  like  all  actinic  rays  are  slightly  inter- 
cepted by  pigment  in  the  skin  and  in  the  blood    (hemo- 
globin) ; 

7.  The  destruction  wrought  by  the  X-rays  is  due  to  dis- 
integration of  the  pigment-carriers    (skin  and  red  blood- 
corpuscles)  ; 

8.  The  therapeutic  action  of  the  X-rays  is  confined  to 
the  place  of  greatest  interception,  ;'.  e.  the  skin. 

These  eight  points  contain  the  principles  of  X-ray 
therapy.  Translating  the  language  of  the  theoretical 
physicist  into  the  therapeutic  directions  which  the  X-ray 
operator  needs  in  his  practical  therapeutic  work,  the  eight 
points  enumerated  above  could  be  formulated  as  follows : 

i.  Generically  speaking,  the  active  principle  of  X-ray 
therapy  and  of  Finsen-light  and  sunlight  is  the  same,  i.  e. 


320  MODERN  PHYSIO-THERAPY. 

the   germicidal,     stimulating   and   destructive    ultra-violet 
force-modality ; 

2.  The  ultra-violet  ray  of  Finsen  is  closer  to  the  violet 
field  of  the  solar  spectrum  than  the  X-rays ; 

3.  The  harder  the  tube,  the  more  penetrating  the  rays, 
— the  softer  the  tube,  the  more  superficial  the  effect ; 

4.  The   harder  the  tube,   the   less   X-ray   energy, — the 
softer  the  tube,  the  greater  the  amount  of  X-ray  energy, 
making  the  soft  tube  the  ideal  therapeutic  tube ; 

5.  The  closer  the  tube  is  to  the  skin  of  the  patient,  the 
more  intense  the  effect ; 

6.  The  X-rays  are  partly  taken  up  by  the  pigment  in 
the  skin  and  in  the  blood.    The  greater  the  amount  of  X-ray 
energy,  the  greater  the  amount  absorbed ; 

7.  The  X-ray,  after  being  partly  absorbed  by  the  skin- 
pigment  and  the  hemoglobin,  first  produces  a  stimulating 
effect.     Through  the  sympathetic  (vaso-motor)  nerves  the 
stimulating  effect  is  reflected  and  thus  a  stimulating  and 
pain-relieving  effect  is  obtained  in  distant  or  deep  struc- 
tures.   If  the  application  is  continued,  overstimulation  takes 
place,  resulting  in  irritation  of  the  pigment-carriers   (skin 
and  blood-corpuscles).     The  skin  reacts  by  a  distinctly  in- 
flammatory process.     The  red  corpuscles  are  disintegrated 
and  the  small  arteries  are  occluded,  causing  local  necrosis  by 
lack  of  nutrition.     If  the  part  is  composed  of  morbid  tis- 
sue, the  latter  dies,  leaving  a  comparatively  healthy  ulcer 
behind.    The  absorption  of  the  X-rays  by  the  red  corpuscles 
explains    the    phosphorescence   of   the   tissues    which    fre- 
quently interferes  with  the  skiagraphic  result.     It  also  ex- 
plains the  appearance  of  an  X-ray  "burn"  in  parts  that  have 
not  been  directly  exposed.     If  an  X-ray  treatment  is  not 
pushed  to  the  extent  of  overstimulation.  it  may  stimulate 
local  nutrition  and  metabolism.     This  explains  the  absorp- 
tion of  growths  after  X-ray  treatment. 

8.  X-ray    therapy    should    be    confined    to    superficial 
lesions.     The  cure  is  accomplished  by  disintegration  and 
subsequent  destruction  of  the  pigment  in  the  red  blood- 


PRINCIPLES  AND  PRACTICE  OF  X-RAY  THERAPY.    321 

corpuscles.  Keeping  in  mind  the  physics  of  the  X-rays  and 
the  physiology  of  their  action  on  organic  tissue,  we  can 
readily  see  that  deep-seated  lesions  are  inaccessible  to  the 
therapeutic  action  of  the  Roentgen  rays..  In  addition  to 
this,  we  know  that  the  therapeutic  effect  is  in  proportion  to 
the  amount  of  X-ray  energy.  Since  the  latter  is  in  inverse 
ratio  to  the  penetrating  power  of  the  rays  and  since  the 
deeper  the  lesion,  the  greater  the  penetration  required,  it 
stands  to  reason  that  energy  is  lost  according  as  we  in- 
crease the  depth  of  penetration. 

The  Technique  of  X-ray  Therapy. 

The  fundamental  law  of  therapeutic  X-ray  work  is  sug- 
gested by  the  necessarily  superficial  character  of  the  thera- 
peutic effect  produced  by  the  Roentgen  rays.  The  soft  or 
low  vacuum-tube  produces  an  abundance  of  X-ray  energy 
with  but  scant  penetrative  power.  The  .soft  tube  is,  there- 
fore, the  therapeutic  tube  par  excellence.  Gauged  by  Wal- 
ter's skiameter  it  should  light  up  three  or  four  of  the  test- 
holes  of  the  instrument.  The  standard  for  an  exposure  is 
ten  inches  distance  between  the  tube  and  the  surface  to  be 
treated.  The  duration  of  the  standard  treatment  is  three 
minutes,  a. treatment  to  be  given  every  other  day.  This 
kind  of  a  treatment  (soft  tube,  distance  ten  inches,  duration 
of  treatment  three  minutes)  would,  under  ordinary  circum- 
stances, produce  a  stimulating  effect  and  result  in  more  ac- 
tive granulation  and  absorption.  It  would  be  indicated  in 
indolent  ulcers,  in  various  forms  of  skin-diseases  due  to 
malnutrition,  in  fact  in  all  conditions  which  demand  an 
increase  in  local  metabolism.  In  most  non-bacterial  skin- 
diseases  the  results  are  not  usually  permanent  because  these 
diseases  are  but  local  expressions  of  systemic  conditions. 
By  lessening  the  distance  between  tube  and  skin,  or  by  con- 
tinuing the  exposure  for  a  longer  time,  or  by  repeating  the 
treatment  every  day,  the  effect  would  be  intensified.  It 
would  be  like  increasing  the  dose  of  a  remedy.  \Yhen  the 
action  of  the  rays  gets  beyond  the  stimulating  point,  the 


322  MODERN    1'n  VSIO-THERAPY. 


effect  is  best  marked.  Whether  the  latter  is 
produced  by  the  action  of  the  ray  on  organisms  of  but  little 
resisting  power,  or  whether  the  germicidal  effect  is  coin- 
cident with  the  accumulation  of  oxygen  in  the  part  treated, 
is  not  quite  clear.  It  has  been  demonstrated,  however,  both 
by  laboratory-experiments  and  on  the  living  subject,  that 
pus-germs  and  the  tubercle-bacillus  soon  are  rendered  inert 
and  finally  die  if  they  are  exposed  to  oxygen.  We  know 
that  currents  of  high  voltage  and  high  frequency  have  an 
effect  on  the  composition  of  the  atmospheric  air  by  their 
affinity  for  oxygen.  How  far  this  affinity  will  affect  the 
oxygen  in  the  body  we  are  as  yet  not  prepared  to  say.  There 
is,  however,  no  doubt  about  the  germicidal  action  which  fol- 
lows applications  of  the  X-rays.  If  the  X-ray  dose  is  in- 
creased still  more,  we  arrive  at  the  point  at  which  destruct- 
ive effects  are  to  be  expected.  A  destructive  treatment 
would  be  administered  by  a  soft  tube  used  every  day  for 
five  to  ten  minutes  at  a  distance  of  ten  inches.  This  is  the 
typical  X-ray  treatment  for  superficial  cancer.  It  is  under- 
stood, of  course,  that  the  stimulating,  germicidal  or  de- 
structive effects  do  net  follow  one  treatment,  but  represent 
the  accumulative  therapeutic  effect  of  a  series  of  treatments. 
It  would  be  folly  to  recognize  iron-clad  rules  which  must 
prevail  under  any  and  all  circumstances  in  every  case.  The 
personal  equation  of  the  patient,  as  apparent  to  the  indi- 
vidualizing judgment  and  to  the  experienced  eye  of  the 
operator,  is  the  unknown  quantity  which  can  not  be  forced 
into  the  tight-fitting  limitations  and  indications  of  a  stereo- 
typed law.  As  long  as  every  patient  presents  a  personal 
equation  of  his  own  to  be  solved  by  the  personal  equation  of 
the  physician,  every  kind  of  therapy  must  necessarily  con- 
tain an  uncertain  element  which  makes  therapeutic  practice 
an  art  rather  than  a  science.  The  suggestions  given  are 
hypothetical.  In  applying  them,  the  experience  of  the 
operator  must  adapt  them  to  concrete  conditions.  This 
may  mean  shortening  or  lengthening  the  exposures,  chang- 
ing the  distance  of  the  tube  from  the  skin,  etc.  It  is  under- 


PRINCIPLES  AND  PRACTICE  OF  X-RAY  THERAPY.    323 


THE  CUSTER  X-RAY   SHIELD. 


324  MODERN  PHYSIO-THERAPY. 

stood,  however,  that  the  tube  must  at  all  times  receive  its 
full  capacity  of  current.  The  current  should  not  overheat 
the  anode  before  the  time  of  exposure  is  over. 

The  surface  to  be  treated  and  the  anodal  disc  should  be 
placed  approximately  parallel  to  each  other.  An  imaginary 
line  drawn  through  the  center  of  either  should  be  at  right 
angles  to  the  plane  of  the  anode  and  to  the  plane  of  the  sur- 
face to  be  treated.  Thus,  if  the  patient  is  lying  on  his  back 
on  a  suitable  table,  the  tube  should  be  placed  directly  over 
the  affected  area.  The  anode  should  be  parallel  to  the  sur- 
face and  should  be  directly  over  it.  The  glass  of  the  tube 
should  be  ten  inches  from  the  area  to  be  treated.  This  is 


CALD WELL'S  THERAPEUTIC  TUBE. 

the  ideal  position.  Variations  from  this  position  are  fre- 
quently necessary  owing  to  the  peculiar  location  of  the 
trouble.  The  tube-stand  should  have  a  lead  shield  attached 
which  has  adjustable  diaphragms  in  its  center  and  is  in- 
terposed between  the  tube  and  the  patient.  This  tube-stand 
is  not  an  absolute  necessity,  but  a  most  desirable  con- 
venience. The  perforation  in  the  center  of  the  diaphragm  is 
placed  directly  over  the  area  to  be  treated.  Pieces  of  sheet- 
lead  are  put  around  the  perforation  so  that  only  the  area  to 
be  exposed  remains  uncovered.  When  no  shield  is  used, 
the  patient  has  to  be  covered  carefully  with  sheet-lead  (not 
lead-foil)  so  that  the  X-rays  can  not  impinge  upon  any  part 
except  the  area  which  is  to  be  treated.  If  the  hand  or  the 
arm  of  the  patient  is  to  be  treated  the  patient  can  sit  on  a 
chair  and  place  his  hand  or  arm  on  a  table.  Otherwise  it  is 


PRINCIPLES  AND  PRACTICE  OF  X-RAY  THERAPY.    325 

by  all  odds  best  to  place  the  patient  on  a  properly  con- 
structed table.  The  recumbent  position  is  most  convenient 
and  comfortable  for  both  patient  and  operator.  Always  be 
careful  to  cover  every  bit  of  skin  that  is  not  to  be  exposed  to 
the  X-rays.  The  lead-dressing  is  the  most  important  part 
of  the  whole  procedure  because  it  limits  the  action  of  the 
rays  and  in  this  way  prevents  X-ray  "burns."  The  latter 
are  really  not  burns.  They  are  evidences  of  reaction,  and 
if  they  occur  in  the  right  place,  have  the  highest  therapeutic 
significance.  Inasmuch  as  reaction  is  necessary,  the  cure 
in  cases  of  morbid  growths  depends  upon  it.  X-ray  burns 
over  large  areas  of  healthy  tissue  are  in  the  majority  of  in- 
stances due  to  faulty  technique  on  the  part  of  the  operator. 
Exposures  should  be  made  in  a  darkened  room  so  that  the 
operator  can  watch  the  phosphorescence  of  the  tube,  should 
be  noiseless  in  order  not  to  frighten  the  patient,  and  should 
be  painless.  The  tube  should  be  properly  attached  to  pre- 
vent sparking.  The  operator  should  not  expose  himself 
unnecessarily,  especially  his  hands  and  eyes.  The  delete- 
rious effects  of  the  X-rays  on  the  procreative  faculty  of  oper- 
ators have  been  emphasized  by  many  observers.  A  tube 
which  has  become  hard  from  constant  use  should  be  allowed 
to  rest  a  week  or  longer  and  then  softened.  The  employ- 
ment of  the  regulating  (softening  or  hardening)  device  on 
overworked  tubes  is  not  conducive  to  preserving  the  tubes. 

Clinical  Indications. 

The  triple  action  of  the  X-rays  (stimulating,  germi- 
cidal,  destructive)  should  be  remembered  in  adapting  means 
to  the  end.  The  operator  should  have  a  clear  pathological 
conception  of  his  case  before  he  can  attempt  to  make  X-ray 
exposures  intelligently.  The  X-ray  is  at  its  best  in  condi- 
tions, where  morbid  tissue  is  to  be  destroyed  and  where  the 
lesion  is  extensive  and  involves  the  subcutaneous  tissues. 
The  following  list  of  diseased  conditions  probably  repre- 
sents the  present  status  of  the  question,  as  suggested  by 
the  study  of  over  500  cases  which  have  been  under  observa- 


326  MODERN  PHYSIO-THERAPY. 

tion  during  the  past  four  years  at  the  Cincinnati  Post-grad- 
uate School  of  Physiological  Therapeutics.  The  directions 
given  should  be  modified  to  suit  the  individual  case. 

ACNE. — In  the  common  form  of  acne  the  results  are  very 
good.  Exposures  every  day  or  two  for  five  minutes.  Dis- 
tance of  moderately  soft  tube  ten  inches.  Protect  the  eyes. 
In  acne  rosacea  the  results  are  not  so  uniformly  good.  Con- 
dition is  likely  to  return. 

CARCINOMA. — Cancer  of  the  breast  does  very  well  in 
the  early  stages.  Treatment  every  other  day  with  moder- 
ately soft  tube  for  ten  minutes.  Distance  ten  inches.  When- 
ever the  lesion  is  at  some  distance  below  the  skin  in  this  or 
any  other  kind  of  a  case,  the  tube  should  be  correspondingly 
harder  to  insure  penetration.  The  results  are  correspond- 
ingly less  certain.  After  the  first  stages  of  breast-cancer 
amputation  is  the  proper  remedy.  It  should  be  followed  by 
X-ray  treatment.  In  cancer  of  the  stomach,  bowels,  rec- 
tum, uterus  or  any  other  deep  organ  the  X-rays,  like  all 
high  potential  force-modalities,  relieve  pain  and  produce  an 
alterant  effect,  thus  prolonging  life.  I  have  never  seen  a 
case  cured  and  doubt  whether  the  reported  cured  cases  of 
this  kind  could  stand  critical  analysis.  I  have  known  of 
pain  being  relieved  by  the  X-ray,  that  resisted  opiates  of 
all  kinds.  Exposures  should  be  at  long  range  (15-20  inches) 
with  a  comparatively  hard  tube.  Ten  minutes  every  day  or 
two. 

ECZEMA. — In  many  cases  of  chronic  eczema,  especially 
the  .vesicular  variety,  the  X-rays  produce  a  cure.  In  nearly 
all  cases  they  relieve  itching  and  lessen  or  stop  the  dis- 
charge. Treatments  with  moderately  soft  tube  for  three 
to  five  minutes  every  other  day.  Distance  five  to  ten  inches. 
Constitutional  treatment  is  imperative  in  all  these  cases. 
Locally  the  high-frequency  current  seems  to  be  better 
adapted  than  the  X-rays. 

EPITHELIOMA,  or  common  skin  cancer,  is  nearly  always 
curable  by  the  X-rays.  Usually  located  in  the  face  (lips, 
nose,  angle  of  eye).  Patients  should  be  treated  every  day 


PRINCIPLES  AND  PRACTICE  OF  X-RAY  THERAPY.    327 

for  five  to  ten  minutes.  Distance  of  soft  tube  five  to  ten 
inches.  If  there  is  much  induration  of  surrounding  or  sub- 
cutaneous tissues,  vacuum  of  the  tube  should  be  somewhat 
higher.  As  soon  as  the  induration  disappears  and  condi- 
tions assume  a  healthy  aspect,  the  addition  of  Finsen's  ac- 
tinic rays  seems  to  accelerate  the  process  of  repair.  Ex- 
posures should  last  from  thirty  minutes  to  an  hour.  In 
reality  this  is  equivalent  to  using  a  force-modality  of  less 
rapid  oscillation  and  greater  wave-length  in  order  to  sup- 
plement the  work  done  by  more  rapid  vibration  and  shorter 
undulation.  The  Finsen-treatment  can  be  advantageously 
added  to  X-ray  exposures  as  soon  as  the  process  of  repair 
has  begun.  As  a  substitute  for  the  Finsen-ray  in  these  cases, 
a  (positive)  brush-discharge  from  a  static  machine  (wooden 
electrode)  answers  nicely. 

FAVUS. — Two  cases  treated  and  both  cured.  Technique 
same  as  in  the  treatment  of  eczema. 

HYPERTRICHOSIS. — I  have  not  been  able  to  produce  more 
than  a  temporary  effect  in  these  cases.  Recurrence  seems 
to  be  the  rule. 

KELOID. — Results  were  negative  in  three  cases.  Pa- 
tients were  colored. 

KERATOSIS  SEXILIS. — Results  are  good  especially  if  the 
excrescence  is  removed  and  the  remaining  denuded  surface 
treated.  Technique  same  as  in  the  treatment  of  eczema. 

LEUKEMIA. — Results  seem  favorable  as  shown  by  gen- 
eral improvement  and  in  a  few  cases  by  blood-count.  .Ex- 
posure over  region  of  spleen  with  comparatively  hard  tube 
for  ten  to  fifteen  minutes  every  two  or  three  days. 

LICHEN  PLANUS. — Out  of  six  cases  two  were  cured,  two 
relieved  and  two  passed  from  notice.  Technique  similar  to 
that  of  eczema. 

LUPUS  VULGARIS. — In  the  hypertrophic  form,  character- 
ized by  nodular  enlargement  and  much  contiguous  involve- 
ment the  X-rays  are  superior  to  the  actinic  rays  of  Finsen 
while  the  latter  are  preferable  in  the  ulcerated  form.  Com- 
paratively hard  tube  for  five  to  ten  minutes  every  day  or 


328  MODERN  PHYSIO-THERAPY. 

two.  In  suitable  cases  the  X-rays  are  almost  a  specific.  In 
the  erythematous  form  of  lupus  (seborrhea  congestiva) 
results  have  not  been  satisfactory.  In  two  cases  aggrava- 
tion seemed  to  follow  X-ray  treatment.  The  high-frequency 
current  seems  to  be  the  proper  agent. 

PRURITUS. — The  neurotic  form  seems  to  respond  very 
well.  Three  cases,  two  cured,  one  relieved.  Frequent  but 
very  short  exposures  by  means  of  a  soft  tube.  The  itching 
of  many  skin-diseases  is  relieved  by  the  X-rays. 

SARCOMA. — Results  uncertain  and  seem  to  vary  even  in 
similar  cases.  Radiotherapeutic  treatment  should  supple- 
ment surgical  interference.  One  case  of  post-nasal  sar- 
coma, which  was  operated  upon  and  referred  to  me  by  a 
local  laryngologist,  was  cured. 

SYCOSIS. — Results  are  good.    Technique  as  in  acne. 

TINEA  TONSURANS. — Results  usually  good.  Technique 
as  in  acne. 

TUBERCULOSIS. — In  the  glandular  form  the  results  are 
good  if  the  infected  glands  are  not  too  deep.  See  technique 
under  Cancer  of  the  Breast.  In  peritoneal  tuberculosis  I 
have  seen  temporary  improvement,  general  and  local.  Tech- 
nique as  in  deep-seated  cancer.  Tuberculosis  of  joints  re- 
sponds favorably  in  many  cases,  if  energetic  general  and 
local  treatment  is  added.  Technique  same  as  in  cancer  of 
the  breast.  Use  a  comparatively  hard  tube.  Skin-tubercu- 
losis responds  to  frequent  exposures  with  a  soft  tube.  Tech- 
nique as  in  lupus.  .  In  tuberculosis  of  the  lungs  X-ray 
therapy  seems  to  be  of  doubtful  value.  The  proper  agent 
locally  seems  to  be  the  high-frequency  current  applied  by 
means  of  a  double  resonator. 

The  best  results  from  X-ray  treatment  are  obtained  in 
epithelioma  of  the  face,  in  the  hypertrophic  form  of  lupus 
and  in  acne.  In  these  conditions  the  X-rays  surpass  any 
and  all  other  agents,  because  they  are  painless,  are  almost 
specific  in  their  action,  and  serve  an  admirable  cosmetic 
purpose,  especially  in  the  common  skin-cancer  of  the  face. 
The  first  and  essential  condition  of  success  in  the  use  of  the 


PRINCIPLES  AND  PRACTICE  OF  X-RAY  THERAPY.    329 

Roentgen  rays  is  knowledge  of  their  physical  properties  and 
the  effect  they  are  capable  of  producing  on  organic  tissue. 
Without  any  knowledge  of  this  most  important  part  of  the 
subject,-  the  art  of  skiagraphy  becomes  amateurish  guess- 
work, the  science  of  X-ray  therapy  a  conglomerate  of  em- 
pirical notions.  There  can  be  no  progress  without  logical 
elaboration  of  the  principles  that  underlie  the  work  we  at- 
tempt to  do  and  the  technique  we  adopt.  Sit  modus  in 
rebus! 


330  MODF.RX     I'llYSIO-TllKKAI'Y. 


CHAPTER  XII. 
SUGGESTION. 

"Cure  her  of  that. 

Canst  thou  not  minister   to  a  mind  diseased, 
Pluck  from  the  memory  a  rooted  sorrow, 
Raze  out  the  written  troubles  of  the  brain, 
And   with   some   sweet  oblivious   antidote 
Cleanse  the  stuffed  bosom  of  that  perilous  stuff 
Which  weighs  upon  the  heart?" — Shakespeare. 

If  we  were  to  eliminate  the  suggestive  element  out  of  the 
practice  of  medicine,  there  would  not  be  enough  left  to  merit 
serious  discussion.  The  theory  of  medicine,  as  gleaned 
from  the  laboratory  or  the  post-mortem  room,  can  subsist 
independently  of  suggestion.  The  moment,  however,  the 
theory  is  translated  into  intelligent  action  in  the  treatment 
of  a  living  organism  which  is  more  than  an  aggregation  of 
cells  or  composition  of  chemical  substances,  it  is  not  any 
more  impossible  to  eliminate  the  suggestive  element  than  to 
take  away  the  personal  equation  of  either  physician  and  pa- 
tient in  the  relations  of  one  to  the  other.  Such  being  the 
case,  suggestion  should  be  studied  and-  understood  like  all 
other  methods  of  therapy.  As  a  matter  of  fact,  it  has 
always  attracted  the  really  great  minds  in  medicine  who 
have  variously  discussed  this  subject  under  the  head  of  men- 
tal medication,  animal  magnetism,  hypnotism,  suggestive 
therapeutics,  psycho-therapy,  etc. 

Suggestion  is  said  to  be  "a  method  of  conscious  or  un- 
conscious control  of  a  person's  mind."  Neither  the  opera- 
tor nor  the  subject  need  necessarily  be  aware  of  the  act  of 
suggestion.  The  medium  through  which  the  suggestive  in- 
fluence is  communicated  is  said  to  be  one  or  more  of  the 


SUGGESTION.  331 

special  senses,  the  eye,  the  ear,  etc.  This  is  true  in  the 
majority  of  instances,  although  the  action  of  mind  upon 
mind  by  means  of  thought-waves  (vibrations  of  the  ether 
intervening  between  brain-cells)  does  not  necessarily  de- 
pend upon  the  interposition  of  the  special  senses.  If 
thought-waves  travel  from  nerve-cell  to  nerve-cell  within 
the  same  nerve-organism  (brain  of  the  same  person),  the 
term  "auto-suggestion"  is  used.  There  is  no  doubt  that 
communication  between  nerve-cells  of  different  nerve-or- 
ganisms (different  persons)  without  the  instrumentality  of 
the  organs  of  special  sense  is  possible,  e.g.,  controlling  the 
mind  of  a  sleeping  person  or  that  of  an  absent  person. 
(See  chapter  on  "FORCE  AND  FORCE  MODALITIES.") 

In  order  to  understand  the  phenomena  of  suggestion,  it 
is  necessary  to  remember  that  the  term  "mind"  refers  to 
the  totality  of  impressions  left  by  the  environments  of  a 
person  throughout  that  person's  life.  A  person  born  with- 
out the  use  of  his  special  senses,  i.e.,  born  blind,  deaf,  etc., 
could  not  possibly  have  "mind."  He  might  have  brain-cells 
capable  of  receiving  and  storing  up  impressions.  Without 
"impre'ssions,"  however,  these  brain-cells  would  be  like  an 
electric  battery  without  wires  or  conductors.  From  the 
first  moment  of  life  the  organs  of  special  sense  carry  im- 
pressions to  the  brain-cells.  The  sum-total  of  these  im- 
pressions is  the  "mind"  of  the  person.  The  store-house  of 
the  impressions  is  the  aggregation  of  brain  cells.  These 
brain-cells  have  a  functional  power  peculiar  to  themselves 
just  as  all  cells  in  the  body,  e.g.,  those  in  the  liver,  in  the 
kidneys,  in  muscle-tissue  have  some  characteristic  inherent 
power  peculiar  to  themselves.  This  diversified  functional 
capacity  represented  by  cells  of  different  kinds  is  bound 
up  in  the  physical  or  anatomic-physiological  make-up  of 
the  person  and,  therefore,  necessarily  a  phenomenon  of 
heredity.  With  reference  to  brain-cells  this  functional 
power  determines  the  degree  of  fitness  of  the  individual  to 
utilize  and  combine  the  sense-impressions.  There  are  in- 
numerable degrees  of  this  fitness  and,  therefore,  there  are 


332  MODERN  PHYSIO-THERAPY. 

innumerable  degrees  of  mentality  from  abject  idiocy  to 
superlative  intellectuality.  The  "fitness"  is  the  hereditary 
element  of  mind  because  it  is  primarily  and  absolutely  a 
result  of  stock-breeding,  in  the  same  sense  as  physical  size, 
strength  or  peculiarity  are  matters  of  pedigree.  Analyzed 
down  to  its  simplest  form  the  functional  power  of  the 
brain-cells  represents  the  ultimate  trace  of  the  sense-im- 
pressions gathered  by  generations  of  ancestors.  Thus  we 
see  that  "mentality"  is  by  no  means  an  arbitrary  concept 
but  a  composite  picture  made  up  of  the  sense-impressions 
gathered  by  the  individual  and  by  the  numerous  individuals 
that  represent  the  stock  whence  he  was  bred. 

The  patient  that  presents  himself  or  herself  for  treat- 
ment represents  an  organism  within  which  the  brain  is  en- 
throned as  the  controlling  element.  In  as  much  as  you 
are  able  to  control  that  brain,'  you  are  able  to  master  the 
organism,  or,  for  that  matter,  the  person.  Keep  in  mind 
that  the  brain  or  control-station  of  your  patient  is  a  com- 
pound of  heredity  and  environment.  The  suggestion  must 
be  within  the  range  of  impressions  gathered  and  elaborated 
by  the  individual,  and  must,  therefore,  be  adapted  to  the 
individual's  mentality.  The  object  in  every  case  must  be 
to  direct  the  patient's  mind-operations  in  conformity  with 
the  suggested  idea  or  mind-image.  Since  the  so-called 
"prevalent  ideas"  control  the  operations  of  the  individual 
mind,  it  is  of  importance  to  adapt  a  suggestion  to  the  "prev- 
alent ideas"  of  the  individual  brain.  By  "prevalent  ideas" 
are  meant  impressions  that  are  strongest  and  of  dominating 
influence.  Impressions  which  by  environment  and  training 
are  constantly  repeated  until  they  become  a  part  of  a  pa- 
tient's mental  individuality,  are  called  "prevalent  ideas." 
The  sum-total  of  these  "prevalent  ideas"  is  what  we  ordi- 
narily mean  by  will-power.  The  will  is  free  in  the  con- 
ditional sense  indicated. 

It  is  plain  that  suggestion  is  the  constant  and  ubiquitous 
companion  of  the  physician  in  his  successful  professional 
work.  There  is  no  way  of  practicing  medicine  without  sug- 


SUGGESTION.  333 

gestion.  Everywhere  and  at  all  times  the  physician's  mind 
controls  mind  and,  through  the  latter,  matter.  The  sugges- 
tion does  not  only  emanate  from  the  physician's  mind.  His 
appearance,  his  demeanor,  his  voice,  his  mode  of  dealing 
with  people,  his  habits,  his  reputation,  his  surroundings, 
the  appearance  of  his  office,  etc.,  etc.,  they  all  are  full  of 
suggestions  to  the  mind  of  the  patient.  What  the  sugges- 
tion will  be,  depends  on  the  mind  that  receives  the  impres- 
sions. The  confidence  of  the  patient  in  his  doctor  is  a  sug- 
gestive influence  emanating  from  the  latter.  The  old  say- 
ing that  "confidence  is  half  the  cure"  contains  a  world  of 
truth.  It  expresses  that  condition  of  attunement  between 
the  controlling  mind  and  the  mind  controlled  which  makes 
the  former  the  complete  master  of  the  situation.  The  phy- 
sician must  control  the  patient's  mind  in  order  to  be  able 
to  influence  his  body. 

It  is  unnecessary  to  point  out  the  tremendous  impor- 
tance of  the  psychic  element  in  its  direct  bearing  on  the 
physical  phenomena  that  constitute  health  and  disease.  The 
thought  or  sight  of  food  is  capable  of  causing  a  flow  of 
saliva.  The  act  of  yawning  or  even  the  thought  of  yawn- 
ing is  frequently  productive  of  a  similar  performance  in 
others.  Diarrhea  following  an  attack  of  fear  or  fright,  the 
fainting  at  the  sight  of  blood,  the  shock  produced  by  sud- 
den announcements,  death  following  psychic  shock  are  il- 
lustrative of  the  great  influence  of  mind  over  body.  The 
practice  of  suggestive  therapy  consists  in  adapting  the  pos- 
sibilities of  this  influence  to  the  requirements  of  clinical 
problems.  The  misapplication  of  this  principle  is  shown  in 
the  production  of  disease  or  symptoms  of  disease  following 
suggestion  or  auto-suggestive  influences.  The  hypochon- 
driac who  rivets  his  mind  on  his  heart  and  constantly  sug- 
gests all  manner  of  heart  disturbances  to  himself,  will  never 
fail  in  producing  the  symptoms  about  which  he  has  read 
or  heard.  The  pregnant  woman  who  is  haunted  by  the 
spectre  of  some  physical  defect  in  her  child,  not  infre- 
quently brings  on  the  very  things  she  abhors  and  fears. 


334  MODERN  PHYSIO-THERAPV. 

Maternal  impressions  illustrate  the  influence  of  mind  over 
body.  The  physician,  in  treating  a  patient,  must  make  this 
tremendously  powerful  psychic  agent  subservient  to  his 
purpose.  His  suggestions  to  his  patient  must  be  few, 
clearly  defined  and  constantly  repeated.  They  must  be  few 
in  order  not  to  attenuate  the  effect  by  scattering  the  force 
of  impressions.  They  must  be  clearly  defined  in  order  to 
make  a  definite  and  positive  impression.  They  must  be 
constantly  repeated  in  order  to  produce  a  lasting  effect  and 
an  increasingly  intense  impression.  Thus :  In  treating  any 
kind  of  a  case,  pick  out  the  one  feature  or  symptom  of  the 
case  upon  which  the  latter  hinges  as  far  as  the  patient  sub- 
jectively is  concerned.  This  one  feature  is  usually  pain  or 
some  other  neurotic  or  nervous  phenomenon.  Rivet  your 
suggestive  therapy  upon  this  one  feature.  Your  suggestion, 
counteracting  a  symptom,  should  be  direct,  firm,  clear  and 
continuous.  Suggestions  need  not  necessarily  be  couched 
in  words.  Your  whole  attitude  and  conduct  should  be  a 
clearly  defined  and  deeply  impressed  suggestion  to  remove, 
alter  or  relieve  the  condition  whatever  the  latter  may  be. 
The  exact  form  in  which  suggestions  are  given  is  variable. 
It  depends  on  the  personality  of  the  physician  and  indi- 
viduality of  the  patient.  It  is  a  case  of  personal  equation 
on  both  sides.  The  choice  of  the  vehicle  which  is  to  carry 
a  suggestion  is  also  a  matter  of  personal  equation.  A  dose 
of  medicine  of  indifferent  composition  might  act  as  a  pow- 
erful and  prompt  anodyne.  This  is  what  doctors  call  a 
placebo.  A  few  gentle  stroking  movements  of  the  hand 
over  a  painful  spot  might  give  instantaneous  relief  by  the 
suggestion  which  accompanies  the  application.  The  prin- 
cipal part  of  the  performance  is  the  complete  attunement 
of  the  patient's  mind  and  the  expectation  of  and  belief  in 
th«  result..  What  a  marvelously  effective  agent  for  good 
this  form  of  mental  medication  is,  has  been  shown  by  the 
results  achieved  by  the  Christian  Scientists.  Their  thera- 
peutic agent  is  suggestion.  The  vehicle  is  prayer  and  a 
more  or  less  melodramatic  exhibition  of  stage-effects. 


SUGGESTION.  335 

AYhile  Christian  Science  is  misnamed  and,  in  its  practice, 
has  all  the  ear-marks  of  charlatanerie  and  buffoonery,  it 
contains  a  grain  of  truth  which  properly  belongs  to  the 
science  and  legitimate  practice  of  medicine.  The  grain  of 
truth  is  the  therapy  of  the  mind  for  the  cure  of  ailments  of 
the  body  (psycho-therapy,  suggestive  therapeutics,  mental 
medication,  suggestion). 

The  range  of  usefulness  of  suggestive  therapy  is  as 
large  as  the  entire  field  of  medicine,  nay  even  larger.  Sug- 
gestion is  the  principal  element  in  the  dealings  of  men 
with  each  other  at  all  times  and  under  all  circumstances. 
In  the  training  and  moral  hygiene  of  childhood  and  ado- 
lescence suggestion  is  a  most  powerful  factor.  The  ethics 
of  religion  stripped  of  its  outward  garb  of  form  and  cere- 
mony is  nothing  but  suggestion.  In  the  management  of 
temperamental  aberrations,  lack  of  balance,  melancholia, 
bad  habits  and  many  forms  of  mental  disease  suggestion  is 
the  one  great  curative  factor.  In  the  treatment  of  insomnia, 
paralytic  or  spasmodic  conditions,  sexual  neuroses  and  psy- 
choses and  all  forms  of  functional  and  reflex  disorders  sug- 
gestion offers  the  best  of  results.  Suggestion  should  be 
persistently  tried  in  constipation,  in  incontinence  of  urine, 
dysmenorrhea,  hysteria,  epileptic  and  epileptoid  conditions, 
in  drug  addictions,  alcoholism;  in  fact,  whenever  and 
wherever  the  will-power  of  the  patient  needs  toning  up 
suggestion  js  the  ubiquitous  curative  agent.  Suggestion 
often  takes  the  place  of  chloroform  in  obstetrics.  That 
operations  can  be  rendered  painless  by  suggestion  is  a  well- 
accredited  fact.  In  the  successful  treatment  of  morphine 
and  cocaine  habitues  as  well  as  alcoholic  subjects  much  can 
be  accomplished  by  suggestion.  Many  cases  are  on  record 
that  were  cured  of  the  drinking  habit  by  a  powerful  sugges- 
tion given  to  the  patient  that  he  would  not  be  able  to  touch 
he  glass  to  his  lips  any  more.  All  attempts  to  bring  a  glass 
of  liquor  to  his  lips  failed.  Suggestion  controlled  the  move- 
ment of  his  arm.  In  the  treatment  of  the  morphine  habit 
the  hand  is  controlled  and  is  rendered  unable  to  wiejd  the 


336  MODERN  PHYSIO-THERAPY. 

syringe.  In  the  alleged  cures  of  drug-habits  of  various 
forms  supposed  to  have  been  produced  by  advertised  nos- 
trums of  different  kinds  the  real  curative  factor  is  sugges- 
tion. The  nostrum  is  merely  the  vehicle  of  suggestion. 

There  are  no  contraindications  to  suggestion  properly 
applied.  It  is  the  necessary  bond  that  links  doctor  to  pa- 
tient and  patient  to  successful  therapy.  The  suggestions  of 
hopefulness  should  be  conveyed  to'  the  patient  and  to  his 
surroundings,  his  friends  and  his  family.  It  should  be 
preceded  by  constant  auto-suggestion  of  the  physician  upon 
himself.  It  will  invariably  be  perpetuated  and  intensified 
by  the  auto-suggestion  of  the  patient  upon  himself.  As  the 
case  develops,  suggestion  should  be  adapted  to  special 
phases  and  symptoms  and  persistently  applied.  Its  efficacy 
is  as  unquestioned  as  its  field  unlimited.  The  American 
people  are  splendid  subjects  for  suggestion.  Individually 
and  collectively  they  respond  to  suggestive  influences  of 
the  press,  the  pulpit  or  even  of  a  designing  individual  like 
Mrs.  Eddy  or  John  Alexander  Dowie.  The  destructive 
and  demoralizing  influence  of  a  morally  tainted  or  ethically 
irresponsible  press  is  incalculable  because  of  its  suggestive 
influence.  It  is  capable  of  literally  creating  a  nation  of 
moral  weaklings  and  criminals.  Every  physician  is  sur- 
rounded by  a  sphere  of  the  suggestive  influence  that  eman- 
ates from  him.  It  should  be  made  subservient  to  the  real 
purposes  of  a  physician's  work,  to-wit :  for  the  good  of  the 
body  and  soul  of  his  fellow-man. 

What  is  the  modus  operandi  of  suggestion?  We  may 
recognize  two  states  of  the  mind.  The  conscious  state  is 
characterized  by  the  reflection  of  the  mind  upon  its  own 
acts.  Whether  this  act  of  reflection  is  the  function  of 
special  brain-cells  or  whether  it  is  due  to  peculiar  combina- 
tions of  the  dendrites  and  other  appendages  of  brain-cells, 
giving  rise  to  new  paths  along  which  vibratory  nerve-im- 
pulses may  travel,  is  immaterial.  When  the  fitness  of  the 
mind  to  reflect  upon  its  own  acts  does  not  exist,  the  mental 
status  is  called  the  sub-conscious  state.  It  is  the  realm  of 


SUGGESTION.  337 

all  those  mysterious  manifestations  and  phenomena  of  soul- 
life  that  have  always  been  a  fruitful  subject  of  psychologic 
experiments  and  speculations.  In  keeping  with  the  division 
previously  given,  the  sub-conscious  state  concerns  that  part 
of  the  mind  which  is  the  sum-total  of  hereditary  impres- 
sions. The  life  of  countless  generations  of  ancestors  is 
reflected  in  the  sub-conscious  state.  The  conscious  state 
includes  the  element  of  individual  experience,  the  sum-total 
of  impressions  gathered  from  the  environments  and  experi- 
ences of  individual  existence.  It  is  the  individual  added  to 
the  genus.  The  conscious  state  bears  a  relation  to  the  sub- 
conscious analogous  to  that  of  plant  to  soil.  In  keeping 
with  the  division  given  we  may  recognize  a  twofold  variety 
of  suggestion  received,  the  conscious  and  the  sub-conscious. 
A  suggestion  given  is  received  by  the  conscious  mind  and 
eventually  percolates  through  the  latter  down  to  the  sub- 
conscious state.  It  becomes  a  part  of  the  power  that  is  the 
motive  element  of  soul-life  (Kant's  Impcrativus  catcgori- 
cus).  The  individual  thinks,  says  and  does  certain  things 
in  response  to  the  presence  of  a  vis  a  tergo  which  is  more 
powerful  than  the  individual.  Therein  lies  the  explanation 
of  the  phenomena  of  suggestion  in  its  most  intense  form  or 
hypnotism.  The  latter  divides  the  mind  into  its  several 
potencies  or  faculties  and  engages  one  or  more  of  the  latter 
independently  of  each  other.  It  would  take  us  beyond  the 
scope  of  our  purpose  to  go  more  deeply  into-  the  physiology 
of  these  phenomena.  The  following  illustrations  will  serve 
to  make  the  subject  practical  and  intelligible. 

In  many  patients  it  is  a  difficult  matter  to  act  upon 
the  conscious  mind  by  suggestion.  Lack  of  concentration 
scatters  the  suggestive  influence.  In  these  cases  the  sub- 
conscious mind  must  be  made  to  receive  the  suggestion  di- 
rectly. This  means  that  the  resistance  of  the  conscious 
mind  must  be  eliminated  by  hypnotic  influence.  The  pa- 
tient is  made  to  sit  or  lie  down  comfortably  clad  in  a 
loosely  fitting  garment.  The  room  must  be  quiet  and  not 
too  light.  Impress  the  patient  in  a  quiet  but  firm  manner 


338  MODERN  PHYSIO-THERAPY. 

with  the  value  of  the  suggestive  method  and  with  the  bene- 
fit he  will  derive  therefrom.  Tell  him  to  put  his  mind  at 
ease  by  trying  to  go  to  sleep.  Tell  him  to  close  his  eyes 
and  go  to  sleep,  sleep,  sleep.  Accompany  the  process  of 
gradually  supervening  somnolence  by  gentle  soft  sugges- 
tions such  as:  "Your  eyelids  are  beginning  to  feel  heavy; 
your  eyes  are  tired  ;  you  cannot  open  them ;  your  eyelids  are 
getting  heavier;  you  are  beginning  to  feel  drowsy;  you  are 
asleep."  From  time  to  time  gentle  strokings  of  the  eyelids 
or  of  the  arms  might  be  added  to  the  spoken  suggestion. 
By  and  by  the  conscious  mind  becomes  inactive  and  the 
sub-conscious  mind  is  ready  for  the  suggestion  which  is 
intended.  When  the  conscious  mind  reawakens,  the  sug- 
gestion, now  firmly  planted  in  the  sub-conscious  mind,  re- 
mains and  is  a  part  of  the  patient's  mentality.  The  alco- 
holic subject  no  longer  craves  his  liquor,  the  drug  habitue 
shows  a  strange  aversion  to  his  favorite  drug,  the  tobacco- 
fiend  does  not  ask  for  the  weed,  insomnia,  somnambulism 
and  all  nervous  symptoms  seem  to  have  disappeared,  afflic- 
tions of  the  mind  do  not  seem  to  exist  any  longer. 

In  the  ordinary  class  of  cases  it  is  not  necessary  to 
hypnotize  the  patient.  It  is  sufficient  to  suggest  to  the  con- 
scious mind  by  words,  by  environment,  by  sense-impres- 
sions, etc.  This  is  the  kind  of  suggestion  that  is  practiced 
by  physicians  consciously  or  unconsciously  in  a  more  or 
less  intense  degree  at  all  times  and  under  all  circumstances. 
Let  this  form  of  suggestion  be  systematized  and  adapted  to 
individual  conditions.  The  physician  should  practice  auto- 
suggestion, to  begin  with.  This  begets  confidence  in  one's 
work  and  fitness  to  accomplish  results.  It  should  be  fol- 
lowed by  suggesting  to  the  patient  firmly  and  persistently 
the  things  that  are  essential  in  the  successful  issue  of  the 
case.  The  control  of  the  physiological  life-phenomena 
through  the  brain-cells  is  a  subject  physicians  should  study 
in  all  its  wonderful  mysterious  relations.  There  is  no  rea- 
son why  the  marvelous  work  done  by  Charcot,  Moll  and 
Bernheim  cannot  be  imitated  by  others.  Let  us  consider, 


SUGGESTION.  339 

in  conclusion,  various  forms  of  suggestion  and  illustrate 
the  possibilities  of  this  vast  subject  by  a  few  pertinent 
examples. 

Superstition,  more  especially  if  connected  with  some 
religious  subject,  has  always  been  a  fruitful  source  of  sug- 
gestion. Evidences  and  examples  of  this  kind  are  found 
among  the  peoples  of  all  ages.  That  these  forms  of  sug- 
gestion were  used  for  the  treatment  and  cure  of  disease 
there  is,  likewise,  no  doubt.  Practices  of  this  kind  were 
common  among  the  ancient  nations,  particularly  these  of 
the  Orient,  where  the  sick  were  cured  by  being  wrapt  in 
the  skins  of  sacred  animals,  by  being  made  to  swallow 
sacred  fluids,  by  the  laying  on  of  hands,  by  songs  and 
incantations.  Among  the  Christian  nations  suggestive  ther- 
apy found  its  expression  in  innumerable  forms  of  worship, 
in  the  use  of  prayers,  relics  and  holy  water. 

Mesmerism  (named  after  the  great  magnetic  healer, 
Friedrich  Anton  Mesmer,  born  1733,  died  181-5)  was  a 
form  of  suggestion  that  held  sway  during  the  second  half 
of  the  eighteenth  century.  The  existence  of  a  mysterious 
force,  called  "animal  magnetism"  was  recognized  and  its 
activity  studied  in  the  treatment  of  the  sick.  Some  thought 
that  this  form  of  magnetism  was  a  physical  force  (Mes- 
merism proper)  and  that  it  passes  from  the  operator  to  the 
patient.  Others  imagined  that  the  whole  world  is  alive  with 
spirits  and  spirit-agencies  and  that  the  phenomena  of  ani- 
mal magnetism  were  due  to  the  intervention  of  suirits  who 
responded  to  the  beck  and  call  of  the  operator. 

Braidism  (named  after  James  Braid,  an  Englishman 
who  produced  an  artificial  sleep  by  fixation  of  the  eyes  of 
the  subject)  was  the  earliest  form  of  hypnotism  proper 
(sleep  produced  by  suggestion).  It  is  thought  by  some, 
notably  Charcot,  to  be  a  neurosis  or  a  hysterical  state. 
Others,  especially  Bernheim,  call  it  a  psychosis.  These 
two  investigators  are  the  founders  of  the  two  great  schools 
of  hypnotism,  Charcot  the  founder  of  the  Paris  school, 
Bernheim  of  the  Nancy  school. 


340  MODERN  PHYSIO-THERAPY. 

Dercum  summarizes  the  methods  of  inducing  the  hyp- 
notic state  under  the  following  three  heads : 

1.  Sensory  impressions,  sudden  or  monotonous,  will 
produce  hypnotic  sleep.  Among  these  are  :gazing  steadily 
at  an  object,  listening  to  monotonous  sounds  or  being  gently 
stroked  at  regular  intervals.  The  impressions  may  be  sud- 
den or  violent  like  the  flare  of  a  bright  light,  a  loud  and 
sudden  noise.  Sense-impressions  that  are  fatiguing  are 
particularly  apt  to  produce  sleep.  Fixation  of  the  eyes  is  a 
most  common  method  of  this  kind. 

2.  Stroking  or  "passes"  were  used  by  Mesmer  and  are 
still  employed  by  some  hypnotiseurs.  That  the  "passes"  of 
some  persons  produce  a  distinct  sensation  of  heat  in  the 
region  over  which  the  "passes"  are  performed,  while  the 
"passes"  of  others  are  productive  of  ice-cold,  otherwise 
disagreeable,  sensations,  is  a  phenomenon  which  I  have 
repeatedly  witnessed. 

3.  Verbal  suggestions  have  already  been  referred  to. 
In  the  use  of  verbal  suggestions  everything  depends  on  the 
influence  and  resourcefulness  of  the  operator. 

Physical  effects  of  suggestive  sleep  are  noted  in  the 
pulse,  the  respiratory  movements,  functions  of  the  special 
senses,  in  the  occurrence  of  paralyses,  spasms  and  other 
nervous  phenomena  (catalepsy,  convulsions,  contractures, 
general  lethargy,  somnambulism). 

What  is  the  difference  between  hypnotism  and  sugges- 
tion? Hypnotism  is  a  form  of  suggestion  involving  a 
species  of  artificial  sleep.  It  is  classified  under  the  head  of 
suggestion  and  represents  a  special  form  of  the  latter. 
Hypnotism  ordinarily  has  no  practical  therapeutic  interest 
for  the  physician.  It  belongs  to  the  neurologist  or  patho- 
psychologist.  The  general  practitioner  should  interest  him- 
self in  the  subject  of  simple  suggestion  (suggestion  with- 
out hypnotic  sleep).  His  success  will  be  in  proportion  to 
the  degree  of  his  appreciation  of  this  wonderful  agent. 

Let  me  conclude  by  a  practical  review  of  the  clinical 


SUGGESTION.  341 

uses  of  suggestion,  as  proven  by  the  experience  of  different 
investigators,  notably  Wetterstrand. 

Insomnia. — The  form  of  insomnia  that  can  be  success- 
fully treated  by  suggestion  is  due  to  neurotic  or  psychic 
causes.  Wetterstrand  considers  suggestion  the  foremost 
therapeutic  agent  in  these  cases,  provided  the  latter  are 
carefully  individualized.  He  often  resorts  to  chloroform 
to  start  the  suggestive  state.  Suggestion  must  be  firm  and 
commanding.  Frequently  the  mcst  stubborn  cases  become 
the  most  easily  tractable  subjects.  MacFarlane  combines 
suggestion  with  massage  for  the  production  of  sleep.  Bern- 
heim  confines  himself  to  verbal  suggestion  and  succeeds  in 
nearly  every  case.  In  a  case  of  insomnia  in  a  hysterical 
subject  I  was  able  to  bring  about  a  cure  by  vibration  of  the 
spine  and  a  firm  suggestion  of  sleep.  The  patient  fre- 
quently fell  asleep  during  the  treatment. 

Headache. — Under  this  head  I  classify  conditions  that 
cannot  be  referred  to  definite  causes,  but  are  ill-defined  in 
their  etiology  and  pathology,  frequently  associated  with  a 
dread  of  noise,  with  photophobia,  general  lethargy  and 
various  nervous  symptoms  (nervous  headache).  These 
conditions  offer  a  most  promising  field  for  suggestive 
therapy. 

Neuralgia. — The  pain  of  so-called  "neuralgic"  condi- 
tions can  usually  be  relieved  by  suggestion,  accompanied  by 
stroking  or  "passes"  over  the  aching  part.  Suggestion 
should  be  tried  in  all  stubborn  cases  of  intercostal  neural- 
gia, tic  douloureux,  sciatica,  etc.  The  use  of  other  physical 
methods  in  conjunction  with  suggestion  is  desirable. 

Paralyses  Due  to  Organic  Causes. — Bernheim  speaks  of 
many  cases  of  this  kind  (hemiplegia,  paraplegia)  that  im- 
proved under  suggestion.  My  own  experience  shows  that 
the  improvement  in  not  a  few  cases  of  paralysis,  treated 
physio-therapeutically,  is  largely  due  to  suggestive  influ- 
ences which  accompany  the  treatment.  In  case  of  partial 
paralysis  of  the  arm  which  I  treated  some  years  ago  im- 


342  MODERN  PHYSIO-THERAPY. 

provement  ceased  when  patient  removed  to  another  city 
where  the  physio-therapeutic  treatment  was  continued  by 
a  perfectly  competent  physician.  When  1  again  began  to 
treat  the  patient,  she  again  improved.  The  importance  of 
the  suggestion  in  some  of  these  cases  should  never  be  lost 
sight  of. 

Locomotor  Ataxia. — As  a  means  to  relieve  pain  sug- 
gestion is  serviceable  in  many  cases.  I  once  witnessed  a 
"magnetic  treatment"  performed  by  a  "magnetic  healer" 
who  knew  nothing  about  medicine  but  certainly  had  a  re- 
markable control  over  some  of  his  subjects.  He  applied 
"passes"  to  the  back  and  legs  of  a  patient  suffering  from 
tabes  and  gave  a  great  deal  of  symptomatic  relief.  In  pass- 
ing his  hands  over  any  one's  skin  he  was  able  to  produce 
sensations  of  intense  heat  or  cold. 

Epilepsy. — There  are  many  authenticated  cases  of  epi- 
lepsy on  record  that  were  cured  by  suggestion.  Wetter- 
strand  attributes  most  cases  of  epilepsy  to  psychic  causes 
and  explains  in  this  way  the  favorable  effect  of  suggestive 
therapy.  I  know  from  observation  that  suggestion  will 
affect  the  time  and  frequency  of  epileptic  attacks. 

Chorea. — All  observers  agree  concerning  the  value  of 
suggestion  in  the  treatment  of  St.  Vitus'  dance.  Goodhart 
combines  it  with  liberal  feeding  and  daily  general  massage. 
Bernheim,  Wetterstrand  and  Moll  depend  on  suggestion 
pure  and  simple.  Wetterstrand  emphasizes  the  importance 
of  definite  and  firm  suggestion,  especially  in  susceptible 
children.  He  often  resorts  to  suggestion  while  the  patient 
is  asleep.  He  places  his  right  hand  gently  and  cautiously 
on  the  forehead  of  the  sleeping  child  and  makes  a  few 
"passes"  over  the  body  with  the  other  hand.  In  an  under- 
tone he  suggests  to  the  sleeping  child  to  continue  sleeping. 
He  raises  the  arm  of  the  child  and  finds  it  in  a  cataleptic 
condition,  showing  that  the  suggestion  has  been  successful 
and  thst  the  operator  and  the  subject  are  en  rapport.  Lie- 
bault  calls  catalepsy  under  these  conditions  "the  visible  ex- 


SUGGESTION.  §  343 

pression  of  the  will  of  the  operator."  When  rapport  has 
been  established,  further  suggestion  can  be  given.  The 
results  are  often  surprisingly  good. 

Stuttering. — Wetterstrand  treated  thirty-one  males  and 
seventeen  females,  curing  eleven  of  the  former  and  five  of 
the  latter  by  suggestion.  Fourteen  males  and  five  females 
were  materially  improved.  In  the  remainder  there  was  no 
change.  In  many  cases,  especially  in  children,  the  sug- 
gestion was  given  during  sleep,  as  indicated  under  the  head 
of  chorea. 

Neurasthenia. — Suggestion  added  to  Weir  Mitchell's 
rest  and  feeding  seems  to  offer  good  prospects  in  the  treat- 
ment of  even  seemingly  hopeless  cases.  Every  physical 
method  is  indicated,  in  one  way  or  another,  in  the  handling 
of  neurasthenics  (hygienic  measures,  mechano-therapy, 
etc.).  If  the  condition  of  the  patient  present  some  promi- 
nent symptom  of  a  psychic  character,  especially  that  of 
despair  or  utter  hopelessness,  suggestion  of  recovery  must 
be  resorted  to.  In  many  cases  complete  hypnotization  is 
necessary.  Suggestion  during  the  hypnotic  state  offers  the 
best  results. 

.  Psychic  and  Mental  Disorders. — Neurologists  and  alien- 
ists agree  that  suggestion  has  a  well-nigh  unlimited  sphere 
of  therapeutic  usefulness  in  the  treatment  of  these  condi- 
tions. From  the  mildest  psychoses  to  the  severest  forms  of 
mania  suggestion  is  applicable.  Many  interesting  cases  of 
nostalgia,  sexual  psychoses,  drug  addictions,  hysteria,  etc., 
that  have  been  treated  successfully  by  suggestion  have  been 
reported. 

Wetterstrand,  in  his  interesting  book  on  Hypnotism,  in- 
cludes in  his  long  list  of  diseases  amenable  to  suggestive 
treatment,  all  of  which  he  illustrates  by  exhaustive  case 
reports,  anemia,  chlorosis,  rheumatic  afflictions,  hemor- 
rhage, especially  uterine,  asthma,  nervous  cough,  diseases 
of  the  heart,  local  congestions,  stomach  disorders,  espe- 
cially nervous  dyspepsia,  diarrhea,  constipation,  inconti- 


344  f  MODKRX     1'lIYSIO-TllEKAPY. 

nence  of  urine,  irritation  at  the  neck  of  the  bladder,  men- 
strual disorders,  etc.  Suggestion  is  useful  in  the  ameliora- 
tion of  distressing  symptoms  of  many  diseases,  such  as 
tuberculosis  and  Bright's  disease.  It  has  successfully  taken 
the  place  of  the  anesthetic  in  surgical  and  obstetrical  cases. 
As  a  therapeutic  agent  in  the  treatment  of  functional  dis- 
eases of  the  nervous  system  it  occupies  the  foremost  place. 


PART  II. 

The    Practice    of     Physiological     Thera- 
peutics. 


THERAPEUTIC  INDEX.  347 


THERAPEUTIC  INDEX. 

Alcoholism. — The  acute  form  can  -be  successfully 
handled  in  the  dry-heat  cylinder.  Flushing  out  the  stomach 
and  irrigation  of  the  colon  should  precede  the  treatment. 
Chronic  alcoholism  requires  isolation,  abstinence,  active 
elimination  through  the  skin  and  bowels  and  stimulating 
(hydro-therapeutic  or  electrical)  applications  to  the  lower 
extremities.  Suggestive  influence,  hygienic  surroundings, 
a  vegetable  diet  are  indicated.  Symptoms  of  individual  cases 
should  be  met  when  they  arise.  Daily  positive  static  insula- 
tion is  very  serviceable. 

Alopecia. — Baldness  may  be  the  result  of  some  consti- 
tutional disorder  (syphilis,  acute  fevers)  or  disease  of  the 
skin  (eczema,  psoriasis,  etc.)  or  may  be  due  to  parasitic  in- 
vasion and  gradual  destruction  of  the  hair-follicles.  The 
curability  of  the  condition  is  in  direct  proportion  to  the 
tractability  and  removability  of  the  cause.  This  holds  good 
with  special  emphasis  in  regard  to  the  first  two  varieties 
named. 

Localized  baldness  (alopecia  areata)  is  due  to  invasion 
of  the  hair-follicles  by  fungoid  parasites.  The  prevalence 
of  the  disease  in  this  country  is  frequently  due  to  ignorance 
of  the  first  principles  of  scalp-hygiene.  The  bad  habit  of 
many  people  hardly  ever  removing  their  head-gear  deprives 
the  scalp  of  the  benefits  of  the  actinic  rays  of  sunlight. 
These  rays  are  destructive  to  germ-life.  Exposure  to  sun- 
light is.  therefore,  the  first  condition  of  treatment.  Liberal 
use  of  soap  and  water  is  next  in  importance.  In  well- 
marked  cases  of  gradually  spreading  and  coalescing  spots 
of  baldness  the  Finsen-rays  and  the  high-frequency  currents 
are  indicated  (ten  to  fifteen  minutes  of  each  every  day). 
The  application  of  a  negative  static  head-spray  (ten  minutes 


348  MODERN  PHYSIO-THERAPY. 

every  day  or  two)  is  of  value.  Cold  douches  thrown  against 
the  infected  area  have  a  tendency  to  stimulate  the  nutrition 
and  resisting  power  of  the  skin.  Alternate  applications  of 
heat  and  cold  are  frequently  employed.  Exhaustion  by 
means  of  a  suitable  vacuum-apparatus  is  useful,  especially 
if  combined  with  high-frequency  applications.  X-rays  are 
of  doubtful  efficacy.  The  general  condition  of  the  patient, 
especially  the  excretory  functions,  should  not  be  ignored. 
Where  the  hair-follicles  are  dead,  treatment  is  useless. 

Amenorrhea. — If  it  is  due  to  some  general  condition, 
treat  the  cause.  Hygienic  directions  are  of  the  utmost  im- 
portance (fresh  air,  sunlight,  nourishing  food,  open  bowels, 
active  skin- function).  Curran  Pope  advises  the  use  of  the 
general  electric-light  bath  followed  by  a  cold  general  spray 
(needle-douche).  At 'the  time  of  the  expected  menstrual 
flow,  hot  foot-baths  and  a  sitz-bath  (vapor)  should  be  given. 
General  massage  is  useful,  following  a  lukewarm  general 
bath  (mild  faradic  current  carried  by  the  water).  Vibra- 
tion over  dorsal  and  all  lumbar  vertebrae  should  be  given 
every  two  or  three  days.  Applications  of  mild  galvanic 
current  (ten  to  twenty  milliamperes)  every  three  clays  for 
ten  to  twenty  minutes,  negative  pole  over  pubes,  positive 
pole  on  the  back.  In  suitable  cases  use  mild  faradic  cur- 
rent by  means  of  a  uterine  electrode,  other  pole  in  cul-de- 
sac  or  on  the  back.  High-frequency  applications  by  vaginal 
electrode  are  useful.  Negative  static  spray  over  pelvis 
answers  well  in  some  cases.  Auto-intoxication  as  the  re- 
sult of  suspended  or  insufficient  menstruation  explains  many 
nervous  disorders  of  women,  hysteria,  melancholia,  head- 
ache, reflex  neuroses,  etc. 

Anal  Fissure. — Positive  zinc-  or  copper-electrode  to 
fissure,  negative  to  abdomen,  galvanism  three  to  eight  mil- 
liamperes for  five  minutes.  If  one  treatment  does  not  cure, 
repeat  it  after  eight  or  ten  days.  (See  HEMORRHOIDS.) 

Anemia. — To  correct  disturbances  in  the  hematopoietic 
apparatus  and  its  functions  a  perfect  hygienic  regime  must 
be  instituted.  (See  chapter  on  PERSONAL  HYGIENE;.) 


THERAPEUTIC  INDEX.  349 

Colon-irrigation,  general  massage,  vibration  of  the  spine, 
over  the  region  of  the  spleen  and  over  the  solar  plexus,  a 
vapor-bath  once  a  week,  cold  douches  to  spine  and  daily 
sun-baths,  with  an  abundance  of  gentle  exercise  and  fresh 
air,  are  the  fundamental  conditions  of  success  in  the  treat- 
ment of  a  case  of  anemia.  The  diet  should  be  liberal  and 
nourishing,  including  more  especially  green  vegetables, 
salads,  cocoa,  raw  egg,  fruit  and  almost  any  kind  of  meat. 
Spinach,  raw  egg  and  scraped  beef  have  always  enjoyed  a 
reputation  as  good  foods  for  anemic  persons;  Sour,  sweet, 
salty  and  high-seasoned  food  is  to  be  avoided.  Milk  is  of 
questionable  value  in  some  cases.  Respiratory  gymnastics 
(see  TUBERCULOSIS  PULMOXUM  and  VALVULAR  DISEASES 
OF  THE  HEART)  and  long  walks  in  the  woods,  especially  in 
cedar  and  pine  woods,  are  to  be  recommended.  Co-existing 
conditions  should  receive  proper  attention.  (See  FUNC- 
TIONAL DISORDERS.)  The  general  high-frequency  treat- 
ment (cage  or  diasolenic  cylinder)  is  of  service  in  all  cases 
of  anemia.  Static  insulation  (positive  for  neurotic  sub- 
jects, negative  in  sluggish  cases)  or  the  positive  and  nega- 
tive static  crown  breeze  alternately  is  very  useful.  The 
same  regime  is  applicable  in  CHLOROSIS,  PERNICIOUS  ANE- 
MIA and  LEUKEMIA.  Sometimes  the  X-rays  seem  to  affect 
leukemic  cases  favorably.  The  high-frequency  current  is 
equally  effective  and  a  great  deal  safer. 

Aneurysm  of  the  Aorta. — Some  cases  are  benefited  by 
systemic  dehydration.  (See  VALVULAR  DISEASES  OF  THE 
HEART.)  The  object  is  to  render  the  blood  thick  and 
coagulable.  Tufnell's  diet  consists  of  bread  and  milk,  each 
two  ounces,  for  breakfast ;  bread,  meat  and  milk,  each  three 
ounces,  for  dinner ;  bread  and  milk,  each  two  ounces,  for 
supper.  Rest  in  bed  with  this  diet  for  a  number  of  months. 
Locally  galvano-puncture  might  be  tried  (both  needles  in 
the  tumor;  some  use  only  the  positive  needle  in  the  tumor). 
The  diagnosis  offers  an  interesting  radiographic  problem. 

Angina  Pectoris. — During  an  attack  apply  a  hot  pack 
to  the  whole  thorax  c.nd  to  the  lower  extremities  and  a  cold 


350  MODERN  PHYSIO-THERAPY. 

compress  to  the  head.  Immersing  the  patient  in  hot  water 
up  to  the  umbilicus  is  beneficial.  Other  means  of  breaking 
up  an  attack  are  given  under  the  head  of  PALPITATION  OF 
THE  HEART.  Try  to  locate  the  cause  and  remove  it.  Gal- 
vanism (positive  over  the  heart,  negative  in  lumbar  region) 
can  be  given  every  day  for  ten  minutes  as  a  heart-tonic. 
For  additional  information  see  FUNCTIONAL,  DISORDERS,  RE- 
FLEX DISORDERS,  DYSPEPSIA,  VALVULAR  DISEASES  OF  THE 
HEART. 

Angioma.— (See  VASCULAR  TUMORS.) 

Aphasia. — Mild  faradism  (electrode  in  each  infra-max- 
illary space  pressing  inward  and  towards  each  other)  is 
useful.  Same  current,  frequent  interruptions  by  means  of 
rheotome.  High-frequency  current  over  neck,  also  rapid, 
mild  vibrations.  Galvanism  (positive  over  spine,  negative 
over  neck,  both  constantly  moving)  is  useful.  Negative 
static  spray  in  front  and  on  both  sides  of  neck.  Look  for 
cause  of  the  condition.  (See  PARALYSIS  and  HYSTERIA.) 

Aphonia. — Treatment  identical  with  that  of  aphasia. 
(See  APHASIA.) 

Appendicitis. — The  treatment  of  an  acute  attack  does 
not  differ  from  that  of  acute  inflammatory  conditions  any- 
where else  in  the  body.  The  general  principles  are  dis- 
cussed under  the  head  of  INFLAMMATION  ( ACUTE)  and 
FEVER.  Post-inflammatory  irritation  is  due  to  a  catarrhal 
condition  in  the  para-typhlitic  connective  tissue  or  to  a 
localized  chronic  inflammation  of  intestinal  or  peritoneal 
tissue  in  the  right  iliac  space.  These  conditions  are  anal- 
ogous to  the  catarrhal  and  the  post-inflammatory  states  in 
the  female  pelvis.  The  common  cause  of  inflammation  in 
the  right  iliac  space  (appendicitis,  typhlitis,  peri-typhlitis, 
para-typhlitis)  is  constipation,  i.  c.  the  retention  of  waste 
in  the  large  intestines.  Physiologically  the  large  intestines 
are  an  unnecessary  encumbrance.  The  appendix  is  prob- 
ably a  remnant  of  an  additional  coil  of  intestine  which  has 
disappeared.  The  colon  is  a  stagnant  sewer  and  as  such  the 
cause  of  most  diseases  to  which  human  flesh  is  heir.  (See 


THERAPEUTIC  INDEX.  351 

COLON-IRRIGATION  and  FUNCTIONAL  DISORDERS.)  Chronic 
appendicitis  requires  eliminative  treatment.  (See  INFLAM- 
MATION, CHRONIC.)  Irrigation  of  the  colon  is  of  the  ut- 
most importance.  Locally  positive  galvanic  applications, 
gentle  massage  of  the  surrounding  parts,  hot  packs  are  in- 
dicated. 

Arterio-sclerosis. — The  therapy  consists  in  the  enforce- 
ment of  mental  and  physical  rest,  open  emunctories,  espe- 
cially kidneys  and  bowels,  abstinence  from  tobacco,  alcohol 
and  from  medicinal  heart-tonics.  (See  VALVULAR  DIS- 
EASES OF  THE  HEART.)  Cold  applications  and  intense  heat 
are  not  safe.  Condition  is  incurable. 

Asphyxia. — Strong  faradic  current  (one  pole  side  of 
neck,  other  pole  over  epigastrium )  interruption  by  means  of 
a  rheotome  every  three  or  five  seconds.  Cold  douches  to 
spine.  Make  thorax  expand  and  contract. 

Asthma. — The  regime  consists  in  the  enforcement  of 
general  hygienic  directions,  active  elimination  and  locally  of 
mild  but  rapid  vibration  or  oscillation  of  the  thorax,  mas- 
sage of  the  muscular  framework  of  the  chest,  depletion  of 
the  circulation  in  the  lungs  by  hydro-therapeutic  treatment 
of  the  lower  portions  of  the  body.  Principles  of  treat- 
ment are  discussed  under  the  head  of  VALVULAR  DISEASES 
OF  THE  HEART,  TUBERCULOSIS  PULMONUM,  EMPHYSEMA. 
If  there  is  an  underlying  cause,  it  should  receive  proper  at- 
tention. (See  REFLEX  DISORDERS,  FUNCTIONAL  DISORDERS, 
DYSPEPSIA,  BRIGHT'S  DISEASE,  CHRONIC.)  To  relieve  an 
acute  attack  of  spasmodic  asthma  give  patient  a  hot  sitz- 
bath  and  alternate  hot  and  cold  douches  to  the  back.  Gal- 
vanism (positive  side  of  neck  below  ear,  negative  over  ante- 
rior chest- wall),  weak  current,  is  useful. 

In  treating  a  case  of  hay-asthma  (hay- fever)  the  exist- 
ence and  tractability  of  a  predisposing  cause  should  be 
taken  into  consideration.  General  eliminative  and  tonic 
treatment  lessens  the  liability  to  attacks  of  this  kind  by  in- 
creasing the  resisting  power  of  the  organism  and  remov- 
ing systemic  predisposing  conditions.  (See  FUNCTIONAL 


352  MODERN  PHYSIO-THERAPY. 

DISORDERS  and  Ri  FLEX  DISORDERS.)  Positive  copper-elec- 
trode  (galvanic)  to  nasal  mucosa,  five  to  ten  milliamperes 
for  ten  minutes  daily,  is  useful.  High-frequency  applica- 
tions (vacuum  electrode)  to  nasal  mucosa  frequently  give 
relief. 

Auto-intoxication  is  n  conditirn  o!"  the  blood  pro  1  need 
by  the  absorption  or  reabsorption  of  substances  which  are 
foreign  to  the  physiological  purposes  of  the  organism.  It 
is  by  all  odds  the  most  prolific  cause  of  chronic  diseases, 
especially  the  so-called  functional  disorders.  The  toxic  de- 
rivatives which  are  the  true  etiological  factors  in  the  causa- 
tion of  many  chronic  diseases,  may  be  products  of  the  phy- 
siological digestive  secretions  and  fluids,  of  normal  prod- 
ucts of  digestion  and  of  abnormal  products  of  bacterial  dis- 
integration of  normal  food.  Active  putrefaction  in  the 
intestinal  canal,  especially  the  colon,  is  produced  by  differ- 
ent forms  of  anerobic  bacteria.  (See  reference  to  organ- 
isms of  this  kind  under  the  head  of  SKIN-DISEASES.  ) 

The  toxic  character  of  these  derivatives  has  been  dem- 
onstrated by  the  effects  on  some  of  the  lower  animals  that 
were  inoculated  with  them,  e.g.,  rabbits  and  guinea-pigs. 
The  common  symptoms  produced  were  tetanic  in  character 
and  resembled  the  spasms  which  are  frequently  caused  by 
intestinal  troubles  in  children.  Injection  of  ammoniacal 
urine  sometimes  produced  fatal  results  in  animals.  Ab- 
sorption of  toxines  from  the  alimentary  tract  usually  gives 
rise  to  nervous  phenomena  or  cutaneous  disorders.  Auto- 
intoxication is  the  true  etiological  factor  in  the  majority  of 
cases  of  headache,  vertigo,  malaise,  biliousness,  nervous- 
ness, neurasthenia,  melancholia,  hypochondriasis,  the 
"blues,"  muscular  pains,  skin  diseases,  nervous  diseases,  in 
fact,  chronic  diseases  of  all  kinds.  (See  FUNCTIONAL  DIS- 
ORDERS, REFLEX  DISORDERS,  RHEUMATISM,  DYSPEPSIA, 
DIABETES,  BRIGHT'S  DISEASE,  NEURALGIA,  etc.,  etc.) 

Bier's  Hyperemia. — The  passive  hyperemia  ns  a  thera- 
peutic measure  with  which  the  name  of  August  Bier  is  as- 
sociated (Bier's  stasis)  is  physiologically  antipodal  to  by- 


THERAPEUTIC  INDEX.  353 

drotherapy  because  it  aims  to  produce  its  characteristic 
effects  through  control  of  the  venous  circulation  primarily, 
while  the  action  of  hydrotherapeutic  applications  is  mainly 
due  to  changes  in  the  arterial  circulation.  That  the  arterial 
system  in  Bier's  method  and  the  venous  system  after  hydro- 
therapeutic  applications  share  in  the  physiological  sum- 
total  of  effects  is  understood,  but  these  effects  are  secon- 
dary to  the  direct  action  of  the  two  methods,  as  suggesed 
above.  Bier's  stasis  is  produced  either  by  compression  or 
by  suction. 

Compression  is  brought  about  by  the  application  of  a 
rubber  bandage.  Bier  applies  the  bandage  rather  loosely 
in  several  layers,  overlapping  each  other.  The  site  of  ap- 
plication is  above  the  place  which  is  to  be  rendered  hyper- 
emic.  The  degree  of  pressure  is  suggested  by  the  effect 
to  be  produced. 

Suction  is  applied  by  placing  the  limb  in  a  suitably  con- 
structed cylinder  preferably  made  of  glass.  The  cylinder 
should  be  long  enough  to  cover  the  part  from  above  to 
below  the  region  to  be  subjected  to  stasis.  Compression  of 
the  part  above  the  cylinder  is  made  by  means  of  a 'rubber 
bandage.  The  cylinder  is  at  each  end  supplied  with  a 
snugly  fitting  "cuff"  which  encircles  the  limb  and  allows  no 
air  to  enter  or  to  escape.  The  air  is  now  pumped  out  of 
the  cylinder,  the  degree  of  intra-cylindrical  pressure  being 
suggested  by  the  action  desired.  Cylinders  of  this  kind  of 
different  size  can  be  purchased  for  this  purpose.  "Dry 
cupping"  for  the  production  of  stasis  is  a  modification  of 
the  motion  method. 

The  frequency  with  which  compression  or  suction  is 
applied,  the  length  of  time  consumed  by  a  treatment,  and 
the  relative  severity  of  the  latter  must  be  adapted  to  the 
requirements  of  each  individual  case. 

The  physiological  effects  which  may  be  produced  by 
Bier's  stasis  are  principally: 

Relief  from  pain.  This  is  supposed  to  be  due  to  the 
diminution  of  toxic  material  in  the  part  treated.  The  nerve- 


354  MODERN  PHYSIO-THERAPY. 

endings  are  less  irritated  by  the  lessened  amount  of  toxic 
elements  and  by  attenuation  of  the  material  which  is 
present  (Bier). 

Germicide!  action.  The  destruction  or,  at  least,  attenu- 
ation of  germs  in  the  part  treated  has  been  abundantly 
demonstrated.  •  Some  explain  it  by  assuming  bactericidal 
properties  of  carbonic  acid.  That  passive  hyperemia  fre- 
quently raises  the  opsonic  index  of  the  part  has  been  con- 
clusively shown. 

Absorptive  action.  Increased  activity  of  the  lymphatics 
during  and  after  stasis  has  been  observed  and  demonstrated 
by  Heidenhain  and  others. 

Solvent  action.  Morbid  substances  undergo  disintegra- 
tion and  solution  as  to  the  result  of  stasis. 

Increased  nutrition.  Hypertrophy  of  certain  parts  due 
to  stasis  is  an  often  observed  phenomenon.  Bier  attributes 
much  importance  to  this  over-nutrition  in  explanation  of 
the  salutary  effects  of  stasis. 

The  therapy  of  Bier's  method  is  applicable  to  a  vast 
number  of  diseases.  Bier  mentions  particularly  four  con- 
ditions which  respond  favorably  to  the  use  of  his  method, 
to-wit:  (1)  Tuberculosis  of  the  joints;  (2)  inflammatory 
conditions  of  the  joints;  (3)  inflammatory  conditions  gen- 
erally; (4)  stiffness  of  the  joints.  By  way  of  a  general 
statement  Bier  adds  that  stasis  is  indicated  in  the  treatment 
of  neuralgia,  rheumatism,  or,  for  that  matter,  any  kind  of 
painful  affliction,  on  account  of  the  markedly  anodyne 
effects  which  follow  applications  of  stasis.  The  therapy  of 
stasis  has  been  much  enlarged  and  elaborated  by  others. 

In  order  to  render  the  lungs  passively  hyperemic  and 
thus  apply  the  principle  of  stasis  to  tuberculosis  pulmonum, 
Bier  proposed  the  very  simple  manipulation  of  making 
these  patients  inspire  through  the  nostrils  under  slight  com- 
pression of  the  nose,  allowing  them  unobstructed  exhalation 
through  the  mouth.  Lately  he  also  used  glass  suction  ap- 
paratus of  various  sizes  and  shapes,  principally  over  the 
apices  of  the  lungs.  Another  observer  tried  to  accomplish 


THERAPEUTIC  INDEX.  355 

the  same  end  by  placing  the  patient  in  a  pronounced  Tren- 
delenburg  posture.  Of  course,  this  procedure  is  rather  dis- 
agreeable for  the  patient,  and  less  effective,  since  in  this 
way  the  blood  can  only  gravitate  to  the  lungs.  However, 
the  method,  if  applied  in  moderate  degree,  should  not  be 
lost  sight  of  as  an  adjuvant. 

Krnst  Kuhn  invented  an  inhalation-mask  for  the  treat- 
ment of  pulmonary  tuberculosis  and  reports  good  resvtlts 
from  its  use.  The  object  is  the  production  of  a  passive 
hyperemia  in  the  lungs,  inhalation  being  slightly  impeded. 
That  patients  with  passively  hyperemic  lungs  hardly  ever 
die  of  tuberculosis  is  a  fact  which  was  already  pointed  out 
by  Rokitanski  who  commented  on  the  apparent  immunity  of 
persons  suffering  from  heart  disease,  and  explained  it  by 
the  existing  passive  congestion  in  the  lungs. 

The  advantages  of  the  mask,  as  pointed  out  by  Kuhn, 
are: 

1.  The  healing  of  the  tubercular  foci  in  the  lungs. 

2.  The  increase  of  red  and  white  blood  corpuscles  as 
well  as  hemoglobin  in  the  blood. 

3.  The  beneficial   influence  of  the  mask  will  nantraliy 
be  best  shown  in  cases  of  incipient  pulmonary  tuberculosis, 
or,  better  still,  when  used  as  a  prophylactic. 

4.  Advanced  cases  are  greatly  benefited  by  it,  as  !o*:j 
as  chronic  toxemia  and  pronounced  weakness  of  the  htH'ri 
do  not  render  impossible  any  kind  of  improvement. 

5.  The  risk  of  hemorrhage  from  the  lungs  does  not  for- 
bid its  use;  on  the  contrary,  there  seems  to  be  a  diminished 
liability  of  a  return,  as  the  granulations  in  the  Inn;*  tissue 
apparently  get  stronger  under  the  application  of  the  mask, 
same  as  we  observe  this  in  granulations  on  the  surface  of 
the  body,  while  under  hyperemic  treatment. 

6.  Postmortem  observations  of  the  lungs  of  a  patient 
who  died  of  chronic  intestinal  tuberculosis,  and  in  whom 
the  mask  had  been  used  for  several  months,  has  shown  the 
foci  isolated  and  surrounded  by  a  mass  of  new-formed  con- 
nective tissue,  the  latter  being  in  the  stage  of  cicatrisation 


356  MODERN  PHYSIO-THERAPY. 

7.  On  account  of  the  larger  quantity  of  blood  being  as- 
pirated into  the  lungs,  more  oxygen  enters  the  circulation; 
furthermore,  that  in  consequence  of  the  resistance  offered 
to  inspiration,  the  entire  system  of  respiratory  muscles  is 
strengthened,  on  the  basis  of  the  idea  underlying  the  well- 
known  "Swedish  movements"  method. 

8.  By  thus  improving  the  constituency  of  the  blood,  the 
use  of  the  mask  not  only  incidentally  improves  the  usual 
anemia  of  phthisical  patients,  but  promises  to  become  one 
of  the  most  powerful  physical  aids,  so  far  as  known  to  us, 
in  our  fight  against  ordinary  anemia. 

9.  According  to  the  degree  of  obstruction  to  inspiration 
arranged  for,  the  mask  produces  the  effect  of  various  alti- 
tudes on  the  general  system;  that  is  to  say,  it  rapidly  in- 
creases the  number"  of  red  and  white  blood  corpuscles,  of 
the  latter  especially  the  polynuclear  neutrophiles,  and  the 
perecentage  of  hemoglobin.     This  is  produced  by  the  irri- 
tating effect  of  the  condition  of  reduced  tension  of  oxygen 
in  the  blood  on  the  blood-producing  tissues  of  the  body, 
principally  on  the  bone  marrow. 

Inasmuch  as  the  increase  of  the  blood  elements  begins 
very  early,  one  hour  after  applying  the  mask,  it  will  be 
interesting  to  watch  whether  this  obstructed  inspiration 
might  not  be  used  to  advantage  in  surgical  patients,  espe- 
cially after  abdominal  operations,  to  produce  artificial  leu- 
cocytosis. 

10.  The  mask  incidentally  has  proved  of  great  benefit  in 
relieving  the  pulmonary  circulation  in  cases  of  advanced 
valvular  disease  of  the  heart,  as  also  in  cases  of  obstinate 
asthma. 

The  effect  of  Bier's  hyperemia  on  infectious  processes 
was  studied  by  Baumgarten,  who  inoculated  the  lower  ex- 
tremities of  rabbits  with  anthrax,  pus-germs,  tubercle  ba- 
cilli, etc.  He  found  that  suppurative  processes  in  the  skin 
and  joints  ran  a  much  more  rapid  and  benign  course  if 
Bier's  method  was  used.  Extensive  infiltrations  did  not  do 
as  well,  probably  owing  to  the  rapid  dissemination  of  the 


THERAPEUTIC  INDEX.  357 

toxins  after  removal  of  the  compression  bandage.  There 
seems  to  be  no  doubt  that  the  exudate  produced  by  Bier's 
compression  has  bactericidal  properties,  although  it  is  in 
this  respect  inferior  to  serum.  The  presence  of  a  germi- 
•  cidal  fluid  is  of  some  therapeutic  significance.  We  must, 
however,  not  lose  sight  of  the  danger  of  liberating  virulent 
toxins  and  endotoxins.  Results  are  doubtful  if  absorption 
is  slow,  or  if  the  arterial  circulation  has  been  impaired,  and 
thus  the  oxygen-supply  has  been  lessened.  For  further 
information  along  these  lines  see  OPSONIC  THERAPY.  Ex- 
cellent results  have  been  produced  by  stasis  in  the  treat- 
ment of  gonorrheal  arthritis  and  incipient  mastitis. 

In  a  general  way  it  is  proper  to  state  that  Bier's  applica- 
tions are  mild,  constriction  being  moderate  and  exhaustion 
only  slight,  so  that  treatments  can  be  continued  for  hours 
and  repeated  daily  without  causing  the  patient  pain  or  even 
inconvenience. 

Birth-marks. — (See  VASCULAR  TUMORS.) 

Bright's  Disease  (Acute). — The  therapy  consists  of  a 
mild,  non-irritating  vegetable  or  milk  diet,  colon-irrigation, 
active  diaphoresis  (dry  heat,  hot  pack,  electric-light  bath) 
and  many  suitable  symptomatic  measures.  (See  BRIGHT'S 
nephritis  may  be  one  of  three  varieties,  the  difference  be- 
tween the  three  varieties  depending  on  the  pathological 
DISEASE  (CHRONIC),  INFLAMMATION  (ACUTE)  and  FEVER.) 

Bright's  Disease  (Chronic). — The  chronic  form  of 
changes  which  take  place  in  the  kidney  or  some  part  of  the 
kidney-structure.  The  condition  known  as  tubal  nephritis, 
parenchymatous  nephritis  or  large  white  kidney  is  charac- 
terized by  an  inflammation  or  catarrh  of  the  tubules  in  the 
renal  cortex.  Another  form  of  chronic  Bright's  disease  is 
an  inflammatory  condition  of  the  connective  tissue  resulting 
in  a  shrinking  and  hardening  of  the  organ  (cirrhosis,  scle- 
rosis, chronic  interstitial  nephritis,  small  red  kidney). 
After  long-continued  suppuration  in  cases  of  bone-disease, 
cancer,  consumption  and  other  wasting  diseases,  the  struc- 
ture of  the  kidney  and  other  internal  organs  is  infiltrated 


358  MoDKKX     PlIYSIO-TlIKRAPY. 

by  a  waxy  substance  and  undergoes  a  lardaceous  or  amy- 
loid degeneration.  The  infiltrate,  while  it  causes  an  enlarged 
appearance  of  the  organs,  presses  upon  the  kidney-structure 
proper  and  produces  atrophic  changes.  The  condition  is 
known  as  the  amyloid  kidney  and  is  analogous  to  similar 
conditions  in  other  organs.  There  are  two  other  forms  of 
chronic  nephritis,  which,  however,  are  comparatively  rare 
and  are  not,  strictly  speaking,  to  be  included  under  the  head 
of  chronic  Bright's  disease,  e.  g.  suppurative  nephritis  (pus 
in  the  pelvis  of  the  kidney)  and  hydronephrosis  (cystic  con- 
dition produced  by  retention  of  urine  in  cases  of  obstruc- 
tion in  the  ureter  or  pressure  of  a  growth,  the  ascending  and 
accumulating  fluid  gradually  causing  atrophy  of  the  kidneys 
by  pressure). 

The  common  forms  of  chronic  Bright's  disease  are  the 
parenchymatous  and  interstitial  varieties.  In  the  former 
the  onset  is  gradual,  the  disease  pursuing  a  chronic  course 
throughout,  at  times  involving  the  inter-tubular  connective 
tissue.  The  interstitial  variety  usually  co-exists  in  the  latter 
stages  of  chronic  diseases  of  the  heart  and  liver.  Both 
varieties  are  essentially  chronic,  sometimes  lasting  for  many 
years.  Much  can  be  done  towards  alleviation  of  these  dis- 
tressing conditions.  Before  degenerative  changes  have  oc- 
curred, the  prognosis  under  physio-therapeutic  regime  is 
favorable  in  many  cases,  especially  if  the  condition  is  not 
produced  by  and  is  not  co-existent  with  some  systemic  dis- 
ease or  disease  of  some  other  organ,  e.  g.  the  heart.  If  it  is, 
the  treatment  would  necessarily  have  to  be  directed  towards 
the  exciting  cause. 

The  triple  object  of  all  methods  of  treatment  in  chronic 
Bright's  disease  is :  ( i )  to  re-establish  the  proper  relation  of 
arterial  and  venous  blood-pressure  in  the  kidneys;  (2)  to 
prevent  the  accumulation  of  waste  products  in  the  system, 
and  (3)  to  relieve  incidental  symptoms.  How  per- 
fectly the  objects  of  treatment  can  be  realized  by  the  in- 
telligent application  of  physio-therapeutic  means,  can  be 
easily  seen  in  the  logical  character  of  these  agents  and  in 


THERAPEUTIC  INDEX.  359 

the  remarkable  results  which  are  effected  by  them  even  in 
many  cases  in  which  drug-therapy  is  without  avail. 

To  re-establish  the  physiological  equilibrium  of  venous 
and  arterial  blood-pressure. — To  unload  the  congested  struc- 
tures, various  hydro-  and  thermo-therapeutic  applications  to 
the  lumbar  region,  to  the  anterior  abdominal  wall  and  to  the 
lower  extremities,  are  serviceable.  The  best  local  applica- 
tion for  this  purpose  is  without  a  doubt  the  cold  moist  pack 
(Priessnitz  method).  It  is  indicated  particularly  in  the 
earlier  stages  of  the  disease  and  only  in  cases  where  the 
systemic  symptoms  are  either  absent  or  are  of  a  very  mild 
type.  If  the  amount  of  albumen  is  large  and  symptoms  of 
uremic  poison  are  present  (headache,  vertigo,  nausea,  etc.), 
hot  applications  are  safer  and  more  effective.  The  reason 
for  this  is  obvious  and  suggests  the  danger  of  all  cold  appli- 
cations in  chronic  Bright's  disease,  more  especially  if  the 
latter  are  used  over  large  areas  of  the  body-surface  for  the 
purpose  of  stimulating  excretion  through  the  skin.  It  is  a 
notorious  fact  that  in  all  cases  of  kidney-trouble  the  char- 
teristic  reaction  upon  which  the  therapeutic  effect  of  a  typ- 
ical, hydro-therapeutic  application  depends  is  very  uncer- 
tain and  even  when  it  does  take  place,  rather  imperfect. 
The  danger  of  internal  congestions  following  cold  applica- 
tion, is  a  factor  which  must  not  be  ignored  in  cases  of 
chronic  renal  inflammations.  The  hyperemia  in  the  sec- 
ondary area  which  is  the  result  of  a  cold  application  to  the 
primary  area  would  mean  a  disastrous  exacerbation  of  the 
inflammatory  condition,  unless  by  a  prompt  and  vigorous 
reaction,  the  primary  area  becomes  hyperemic  and  the  sec- 
ondary area  correspondingly  anemic.  With  a  complete  and 
prompt  reaction  the  cold  hydro-therapeutic  applications 
would  be  ideally  available  in  cases  of  chronic  Bright's  dis- 
ease. They  would  be  by  their  "derivating"  action  most  effect- 
ive antiphlogistic  agents.  However,  owing  to  the  tendency 
towards  venous  congestions  in  all  cases  of  chronic  kidney- 
trouble  and  the  notoriously  uncertain  character  of  reaction, 
the  hot,  moist  application  is  by  far  safer  and  more  effective. 


360  MODERN  PHYSIO-THERAPY. 

It  should  be  long-continued  and  often  repeated.  Incidentally 
it  is  a  splendid  anodyne,  if  applied  to  the  small  of  the  back. 
General  massage  judiciously  administered  two  or  three  times 
a  week  is  a  valuable  depletent  agent.  It  has  a  diuretic  ac- 
tion, increases  the  amount  of  uric  acid  and  solids  in  the 
urine,  stimulates  assimilation  and  facilitates  the  conversion 
of  albumins  in  the  economy.  These  effects  can  be  intensi- 
fied by  deep  vibration  over  the  first  three  lumbar  vertebrae, 
given  every  other  day  for  five  or  ten  minutes.  The  renal 
ganglia  are  thus  kept  active  and  well  nourished.  The  tend- 
ency in  many  cases  is  towards  atrophy  of  the  ganglia. 

Dietetic  directions  are  of  great  importance  because  they 
are  capable  of  affecting  the  circulation  in  the  kidneys  by 
lessening  the  functional  activity  of  excretion.  The  object  is 
tc  relieve  the  effort  of  renal  excretion.  Exclude  nitrog- 
enous food  as  much  as  possible.  Milk  should  be  the  main- 
stay of  the  patient.  Suitable  quantities  of  fats,  cream-butter 
and  starchy  foods  should  be  allowed.  Water  should  be 
given  freely.  If  digestion  is  good,  weak  coffee  or  tea  is  not 
objectionable.  Strong  coffee  or  tea  should  never  be  al- 
lowed. Alcoholic  stimulants  should  be  positively  excluded, 
because  they  are  renal  irritants  in  proportion  to  the  amount 
of  alcohol  they  contain.  Irrigation  of  the  colon  by  means  of 
hot  water  is  useful.  The  drinking  of  large  quantities  of  hot 
water  has  been  recommended  by  many  observers.  Raw 
fruit  is  of  the  greatest  value  in  these  cases. 

Electricity  might  be  employed  in  various  ways  in  these 
cases  to  produce  counter-irritant  and  depletent  effects.  Gal- 
vanization by  means  of  3  large  (negative)  plate-electrode 
over  the  lumbar  region  and  a  (positive)  sponge-electrode 
at  some  distance,  might  be  advantageously  employed  every 
day  or  every  other  day  for  ten  minutes.  An  indirect  static 
spray  or  the  wave-current  with  pieces  of  block-tin  applied  to 
the  lumbar  region  is  of  benefit.  A  high-frequency  current 
applied  by  means  of  a  vacuum-electrode  to  the  small  of  the 
back,  has  a  good  effect,  especially  in  cases  suffering  from 
pain  in  the  back. 


THERAPEUTIC  INDEX.  361 

Similar  effects  may  be  produced  by  the  Minin  light,  the 
local  electric-light  bath  and  the  small  dry-heat  cylinder.  The 
object  is  to  increase  the  cutaneous  circulation  and  excretion 
in  the  lumbar  region  and  to  deplete  the  kidneys  in  this  way. 
Care  must  be  taken  not  to  overstimulate  or  even  burn  the 
skin. 

To  prevent  the  accumulation  of  ifaste-products  in  the 
system. — The  skin  in  all  these  cases  must  be  forced  to  per- 
form a  compensatory  function.  Its  activity  should  be  stim- 
ulated. In  this  way  the  excretion  of  toxic  material  is  facili- 
tated and  the  occurrence  of  grave  systemic  complications 
prevented.  The  advantages  of  a  dry,  warm  climate  are  ap- 
parent. Cold  air  contracts  the  superficial  vessels  and  lessens 
the  activity  of  the  skin.  Warm  air  keeps  the  skin  active.  If 
the  air  is  dry.  it  enhances  the  exhalation  and  evaporation  of 
moisture  from  the  lungs  and  skin.  Patients  should  be  taught 
to  wear  woolen  underwear. 

Therapeutically  the  employment  of  intense  dry  heat  is  of 
the  greatest  value.  There  is  no  single  therapeutic  agent  that 
can  be  approximately  compared  to  the  dry-heat  cylinder  or 
the  electric-light  bath  in  cases  of  chronic  Bright's  disease. 
In  most  cases,  especially  if  the  heart  has  not  given  rise  to 
symptoms  on  the  part  of  the  venous  circulation  (edema), 
two  or  three  mild  sweat-baths  in  the  dry -heat  or  electric- 
light  cylinder  have  the  proper  diaphoretic  and  excretory 
effect.  The  bath  should  not  be  carried  beyond  the  point  of 
tolerance.  It  should  not  weaken  the  patient  nor  cause  too 
active  excretion.  The  stimulating  effect  of  light  makes  the 
electric-light  bath  especially  valuable.  After  a  bath  in  the 
dry-heat  cylinder  the  patient  should  rest  for  hours  and  par- 
take, of  liberal  potions  of  water.  On  the  intervening  days 
the  sun-bath  is  of  value.  In  administering  baths  in  the  dry- 
heat  cylinder,  gentle  diaphoretic  effects  should  be  aimed  at. 
It  is  by  far  better  to  give  these  baths  every  other  day  and 
thus  promote  continuous  excretions  without  depression  than 
to  subject  the  patient  to  a  powerful  drain  on  his  system  once 
a  week.  Patients  of  this  class  do  not  recuperate  very 


362 


MODERN  PHYSIO-THERAPY. 


promptly  after  depressing  sweat-baths.  Heart-symptoms 
frequently  arise  in  cases  that  had  previously  been  free  from 
circulatory  disturbances.  If  mild  baths  are  administered 
frequently,  the  organism  usually  responds  most  gratefully 


ELECTRIC  LIGHT  BATH. 


by  continuing  moderately  active  excretion  through  the  skin 
for  many  weeks  even  after  the  dry-heat  treatment  has  been 
discontinued.  In  this  way  most  wonderful  improvement 
can  be  brought  about. 


THERAPEUTIC  INDEX.  363 

The  physiological  effects  of  intense  heat  which  take  place 
in  the  organism  independently  of  the  diaphoretic  action,  are 
to  a  large  extent  illusory  in  cases  of  nephritis.  The  employ- 
ment of  200° -300°  F.,  until  profuse  diaphoresis  takes  place, 
is  recommended  by  Winternitz  and  is  advocated  by  most 
observers  who  have  had  experience  in  these  cases.  The  ob- 
ject in  these  cases  is  elimination. 

If  the  dry-heat  or  electric-light  bath  is  not  available, 
hydro-therapeutic  applications  may  be  employed  with  ad- 
vantage. The  best  are  the  hot-immersion  bath  and  the  hot 
moist  pack.  Cold  applications  are  nearly  always  contra-in- 
dicated in  these  cases.  The  use  of  the  hot  needle-spray  (fine 
douche)  is  followed  by  most  salutary  effects.  • 

In  the  parenchymatous  variety  of  chronic  nephritis  con- 
stant albuminuria  is  the  rule.  Under  the  dry-heat  eliminat- 
ive  treatment  the  quantity  of  albumen  will  gradually  lessen, 
while  the  quantity  of  urine  may  increase.  Edematous  swell- 
ings are  gradually  absorbed.  The  number  of  blood-cor- 
puscles in  the  urine  decrease  while  the  evidences  of  anemia 
eventually  disappear.  In  most  of  these  cases  the  urine  is 
loaded  with  all  kinds  of  renal  casts,  epithelium  and  pus- 
cells.  Urates  and  phosphates  are  present  in  large  quanti- 
ties. By  careful  examination  of  the  urine  the  course  of 
improvement  during  the  eliminative  treatment  can  be 
watched.  Casts  and  blood-cells  will  disappear  while  epithe- 
lial cells  may  continue  to  show.  The  amount  of  urates  and 
phosphates  slowly  diminishes. 

In  cases  of  chronic  interstitial  nephritis  the  evidences  of 
improvement  are  even  more  striking.  In  these  cases  certain 
systemic  symptoms  predominate  while  the  kidney-symp- 
toms (albuminuria)  are  frequently  absent.  The  heart- 
symptoms  in  these  cases  are  characteristic  (hypertrophy  of 
the  heart,  increase  of  arterial  tension).  Casts  in  the  urine 
are  rarely  found.  Uremic  attacks  are  the  rule  in  these  cases. 
Apoplexy  frequently  occurs.  The  eliminative  treatment  by 
means  of  the  dry-heat  cylinder  or  electric-light  bath  les- 
sens the  severity  of  the  uremic  symptoms.  Eventually  the 


364  MODERN  PHYSIO-THERAPY. 

uremic  attacks  cease.  The  heart-symptoms  are  the  most 
stubborn  to  handle.  Owing  to  the  increased  arterial  pres- 
sure and  the  coincident  liability  to  hemorrhage  from  rup- 
tured vessel- walls,  the  treatment  must  be  administered  with 
a  great  deal  of  care. 

In  chronic  parenchymatous  nephritis  the  indirect  nega- 
tive static  spray  is  of  value.  It  enhances  elimination.  In 
cases  of  interstitial  nephritis  the  positive  insulation  may  be 
employed  as  an  effective  circulatory  sedative.  The  use  of 
the  high-frequency  cylinder  is  indicated  in  both  varieties 
The  high-frequency  current  acts  as  a  trophic  (vaso-motor) 
alterant  and  stimulates  the  organs  which  are  concerned  in 
the  process  of  catabolism.  The  use  of  a  mild  galvanic  cur- 
tent  by  means  of  a  warm  half-bath  (positive  pole  in  the 
water,  negative  pole  to  the  neck)  frequently  produces  a 
good  effect.  Blue-light  exposures  have  been  found  service- 
able in  many  cases. 

The  diet  of  a  nephritic  subject  has  already  been  referred 
to.  I  beg  to  remind  the  reader  that  the  production  of 
Bright's  disease  in  dogs  and  men  by  an  exclusive  nitrog- 
enous diet  has  been  experimentally  shown.  A  nitrogenous 
diet  is,  therefore,  contra-indicated  in  cases  of  nephritis. 
The  diet  should  be  mixed,  with  a  preponderance  of  carbo- 
hydrates and  vegetable  albumen.  Fats  in  moderate  quan- 
tity are  allowable.  Red  meats  are  less  objectionable  than 
white  meats.  Milk  is  the  most  important  food.  Fruit, 
green  vegetables  and  rice  can  be  given  in  liberal  quantities. 
According  to  Tyson  the  precise  line  of  dietetic  procedure 
may  be  facilitated  by  indicating  the  daily  physiologic  quan- 
tity of  food  which  is,  approximately  no  gm.  to  130  gm.  of 
albumin,  350  gm.  to  400  gm.  of  carbo-hydrates,  75  gm.  to 
no  gm.  of  fat,  2,500  gm.  to  3,000  gm.  of  water,  and  18  gm. 
to  30  gm.  of  inorganic  salts.  Expressed  in  different  terms, 
the  body"  needs  from  2,000  to  2,400  calories  per  diem  during 
rest,  and  2,400  to  3,000  calories  during  hard  labor.  This 
should  consist  of  about  600  calories  of  proteids,  1,200  calo- 
ries of  carbo-hydrates,  and  600  calories  of  fat.  It  may 


THERAPEUTIC  INDEX.  365 

prove  helpful  to  remember  that  100  gm.  of  meat  represent 
213  calories,  and  one  glass  of  milk  equals  128  calories, 
and  an  ordinary  slice  of  bread  (30  gm.)  equals  64  calories, 
while  1 8  gm.  of  butter  equals  8  calories.  The  maximum 
amount  of  food  physiologically  required  is  also  required  in 
chronic  nephritis,  otherwise  subnutrition  will  manifest  it- 
self by  anemia  and  loss  of  flesh  and  strength.  The  experi- 
ments of  Van  Noorden  have  shown  that,  calculating  on  the 
basis  of  70  kg.  body-weight,  that  in  men  from  13  to  16  gm. 
of  nitrogen,  and  in  women  n  gm.  to  14  gm.,  are  ingested 
daily  by  nephritic  patients  who  enjoy  good  general  health. 
When  the  ingestion  of  albumin  is  increased,  so  that  consid- 
erably more  than  15  gm.  of  nitrogen  daily  have  to  be  ex- 
creted by  the  kidneys,  elimination  becomes  irregular  and 
uncertain.  Van  Noorden  also  demonstrated  that  most  me- 
dicinal substances  (potassium  iodide,  salicylic  acid,  quinin, 
atropin,  etc.)  are  not  eliminated  by  the  kidneys  but  act  as 
irritants,  which  is  a  point  of  some  importance  in  connection 
with  the  subject  of  chronic  nephritis.  The  advantages  of 
water-drinking  in  these  cases  can  not  be  too  often  repeated 
no£  too  strongly  emphasized. 

To  Relieve  Incidental  Symptoms. — Attacks  of  acute 
uremia  and  symptoms  due  to  uremia  (headache,  vertigo, 
nausea,  vomiting,  defective  vision,  asthma)  require  active 
eliminative  treatment.  Hot  baths,  dry-heat  baths,  electric- 
light  baths  are  indicated.  Catheterization  and  Colon-flush- 
ing should  be  practiced  in  acute  attacks  of  uremia.  Hot 
water  should  be  introduced  in  large  quantities  into  the  stom- 
ach and  the  colon.  Forcible  dilatation  of  the  rectal  sphincter 
reacts  on  the  vaso-motors  of  the  skin  and  augments  the 
excretory  efforts  of  the  skin. 

Irritability  of  the  bladder  can  be  allayed  by  applications 
of  heat  to  the  supra-pubic  region  and  irrigation  of  the  blad- 
der with  hot  water.  Hot  rectal  injections  frequently  give 
prompt  relief.  Vibration  over  the  lumbar  vertebrae  and 
peripheral  vibration  by  means  of  a  soft  rubber  tube  intro- 
duced up  to  the  neck  of  the  bladder  are  serviceable.  Kara- 


366  MODERN  PHYSIO-THERAPY. 

dization  (one  pole  on  perineum,  other  pole  over  bladder) 
is  useful.  Galvanization  answers  better  in  some  cases. 
Static  sparks  to  the  perineum  and  to  the  lumbar  centers  are 
recommended  by  some.  The  wave-current  applied  to  the 
perineum  is  useful.  In  some  cases  the  indirect  static  spray 
(positive)  to  the  supra-pubic  region  is  of  service. 

For  the  relief  of  edema,  especially  of  the  feet,  deep  cen- 
tripetal effleurage  should  be  practiced. 

Neuralgic  pains,  which  are  common  in  chronic  Bright's 
disease,  usually  yield  to  the  eliminative  measures  spoken  of. 
Vibration  along  the  course  of  the  aching  nerve  is  a  valuable 
addition.  The  effect  can  be  enhanced  by  a  positive  static 
spray  or  a  high-frequency  application.  Local  applications 
of  heat  are  always  serviceable.  Cupping  (by  means  of  ex- 
haust-pump and  vacuum-tube)  is  useful. 

General  anemia,  weakness  and  disorders  due  to  disturb- 
ance of  central  nerve-function  are  best  treated  in  D'Arson- 
val's  cage  or  in  the  diasolenic  cylinder. 

Failure  of  the  circulation,  especially  attacks  of  syncope, 
call  for  stimulating  measures.  Cold  douches  to  the  back 
are  proper  in  extreme  cases.  Faradism  applied  to  the 
pneumogastric  and  phrenic  nerves,  static  sparks  to  the  car- 
diac apex,  general  faradization  in  the  bath  and  alternate 
applications  of  heat  and  cold  to  the  cervical  and  upper  dor- 
sal regions  will  frequently  bridge  a  patient  over  difficulties 
of  this  kind. 

If  chronic  kidney-troubles  are  secondary  to  some  other 
disease  o:  co-existent  with  disease  in  some  other  organ,  the 
clinical  indications  will  have  to  be  modified  and  adapted  ac- 
cordingly. 

Bronchitis. — The  management  of  an  acute  attack 
should  be  governed  by  the  therapeutic  principles  given  un- 
der the  head  of  PNEUMONIA.  (See  also  COUGH,  INFLAM- 
MATION (ACUTE)  and  FEVER.) 

The  treatment  of  chronic  bronchitis  (bronchial  catarrh) 
requires  careful  individualization.  Bronchial  catarrh  in  the 
advanced  stages  is  frequently  due  to  and  associated  with 


THERAPEUTIC  INDEX.  367 

diseases  of  the  heart,  lungs,  kidneys  and  other  chronic  con- 
ditions. Chronic  bronchitis  may  be  due  to  atmospheric  con- 
ditions, insufficient  skin- function  or  a  catarrhal  tendency 
which  is  common  in  persons  whose  circulation  is  sluggish. 
The  general  features  of  treatment  are  discussed  under  the 
head  of  INFLAMMATION  (chronic)  and  COUGH.  The  local 
treatment  should  be  adapted  to  the  symptoms  of  the  indi- 
vidual case.  Breathing  exercises  and  chest-massage,  as 
discussed  under  the  head  of  TUBERCULOSIS  PULMONUM, 
are  useful  in  many  cases,  especially  if  the  cough  is  dry  and 
periodical  (winter-cough).  Many  electro-therapeutic  ap- 
plications are  serviceable,  to  wit :  faradization  or  galvaniza- 
tion of  the  vagus  (side  of  neck  to  intra-clavicular  space  or 
epigastrium  or  moved  about),  galvanization  of  the  cord 
(nape  of  the  neck  to  front  of  chest),  negative  static  spray 
to  chest,  if  intra-thoracic  congestion  is  well  marked.  Vibra- 
tion over  cervical  region  and  over  thorax  is  useful.  Electro- 
therapeutic  and  vibratory  treatment  should  not  last  longer 
than  fifteen  minutes  and  should  be  given  every  day  or  two. 
Inhalation  of  largely  diluted  ozone  sometimes  relieves  cough 
and  dyspepsia.  A  static  insulation  often  checks  spasmodic 
cough.  At  times  a  change  of  climate  is  necessary.  If  bron- 
chial catarrh  is  secondary  to  some  other  condition,  treat  the 
latter.  Recurrent  bronchial  catarrh  in  an  apparently  healthy 
person  should  call  for  energetic  measures  to  harden  the 
patient  and  to  improve  the  reactive  tone  of  the  skin.  Cold 
moist  packs  to  the  chest,  cold  douches  to  the  back  and  to 
the  thighs  and  walking  in  wet  grass  should  be  prescribed  for 
the  patient.  Outdoor  sports,  especially  rowing,  swimming 
and  horseback  exercise,  are  very  serviceable  in  these  cases. 

Bruise  (Contusion). — In  recent  and  comparatively  mild 
cases  reaction  and  absorption  should  be  produced  by  suita- 
ble means  of  applying  heat  or  counter-irritation  (thermic 
cylinder,  Minin  light,  electric-light  bath,  exhaustion  by  cups 
as  suggested  by  Bier,  hot-water  applications,  immersion  in 
hot- water  bath).  After  treatment  with  any  of  these  agents, 
the  skin  should  be  lubricated  and  massage  gently  and  uni- 


368  MODERN  PHYSIO-THERAPY. 

formly  applied  to  help  in  the  distribution  of  extravasations 
and  exudations.  Static  spray  and  galvanization  (positive 
pole  to  affected  area)  are  sometimes  useful.  When  absorp- 
tion has  begun  local  applications  of  a  high-frequency  cur- 
rent are  of  advantage.  If  the  contused  region  is  very  ex- 
tensive, heat  and  massage  should  be  depended  upon.  If  the 
arm  or  leg  is  the  seat  of  the  contusion,  constant  immersion 
in  hot  water  (flowing,  if  possible)  is  indicated.  If  the  in- 
jury to  the  tissues  is  so  severe  as  to  have  caused  sloughing 
or  gangrene,  the  constant  immersion  in  hot  water  is  by  far 
the  best  treatment.  It  preserves  the  viable  elements  and 
facilitates  excretion  of  the  discharges  and  sloughs.  In  this 
way  it  promotes  repair  and  prevents  sepsis,  not  to  speak  of 
the  prompt  and  decided  analgesic  effect.  In  these  cases  no 
other  treatment  should  be  resorted  to  as  long  as  there  is  any 
morbid  material  left  in  the  affected  part.  In  superficial 
cases  exposure  to  sunlight  is  beneficial.  If  the  bruises  are 
multiple  and  involve  different  parts  of  the  body,  the  whole 
body  should  be  immersed  in  hot  water  and  then  subjected  to 
gentle  stimulating  massage.  The  electric-light  bath  and 
the  sun-bath  are  very  useful  in  these  cases.  If  extravasation 
is  considerable,  vacuum-cupping  should  be  resorted  to.  The 
application  of  cold  is  contra-indicated  in  cases  of  contusion. 
Calculi. — The  statement  made  by  Schroth  that  concre- 
tions in  the  bladder,  kidneys  and  liver  are  but  rarely  found 
in  vegetarian  animals,  seems  to  have  a  deep  therapeutic  sig- 
nificance in  the  treatment  of  the  underlying  condition.  It  is 
essential  to  increase  the  watery  constituents  of  a  patient's 
diet.  Schroth's  statement  is  borne  out  by  the  comparative 
rarity  of  calculi  among  the  Chinese.  Radiographically  it  is 
of  interest  to  know  that  gall-stones  offer  little  or  no  obstacle 
to  the  X-rays  and  can,  therefore,  not  be  skiagraphed.  I  have 
come  to  this  conclusion  after  at  least  a  dozen  attempts  to 
skiagraph  gall-stones  which  had  been  removed  surgically 
and  were  placed  directly  upon  the  envelope  containing  the 
plate.  In  one  or  two  instances  a  very  faint  shadow  was 
produced,  probably  due  to  the  presence  of  a  large  quantity 


THERAPEUTIC  INDEX.  369 

of  bile-pigment  or  lime-salts.  Gall-stones  held  up  to 
the  fluoroscopic  screen  by  the  hand  of  the  operator  can 
not  be  seen.  The  statements  made  by  Wm.  B.  Snow  in  his 
excellent  book  on  Static  Electricity,  etc.,  in  regard  to  this 
subject  I  have  not  been  able  to  verify. — The  internal  use  of 
hot  olive  oil  in  the  treatment  of  gall-stones  is  to  be  com- 
mended. The  effect  is  mechanical. 

Cancer. — (See  chapter  on  X-RAY  THERAPY,  also  INOP- 
i::<AuuE  MAUGXAXT  DISEASE  and  GASTRIC  CANCER.) 

Compressed  Air. — The  use  of  the  pneumatic  chamber 
should  be  based  upon  the  knowledge  of  the  effects  that  can 
be  produced  and  of  the  possible  dangers.  The  effects  of 
compressed  air  are  retardation  of  the  number  of  respiratory 
movements,  increase  in  the  depth  of  the  latter ;  lessening  of 
the  frequency  of  the  heart-beats,  depression  of  the  capillary 
circulation,  increase  in  the  amount  of  waste-products,  nota- 
bly urea  and  CO  2  and  variable  effects  on  the  nervous  sys- 
tem (depression  and  languor  in  some,  stimulation  and  ex- 
citement in  .others).  Clinically  the  best  results  have  been 
achieved  in  emphysema,  delayed  absorption  of  the  pleural 
effusion,  valvular  diseases  of  the  heart  with  imperfect  com- 
pensation ;  fair  results  in  anemia,  chlorosis,  affections  of  the 
middle  and  internal  ear,  pertussis,  capillary  hemorrhage, 
diabetes,  obesity  and  cerebral  congestions.  A  compressed- 
air  treatment  is  said  to  facilitate  the  reduction  of  hernia. 
The  compressed-air  chamber  is  contra-indicated  in  all  forms 
of  capillary  bronchitis,  for  mechanical  reasons  in  ascites, 
hydro-thorax,  abdominal  tumors,  in  disease  of  the  heart 
muscle,  high  fever,  hemorrhagic  tendency  and  in  the  last 
stages  of  tuberculosis.  Compressed  air  is  sometimes  called 
condensed  air.  The  effects  of  rarefied  air  are  suggested  by 
the  indications  which  are  met  by  high  altitudes  (mountain- 
air).  Rarefied  air  acts  favorably  in  all  cases  of  disturbed 
cellular  nutrition,  disorders  of  metabolism,  and,  therefore,  in 
disease  of  the  respiratory  and  circulatory  apparatus.  (See 
TUBERCULOSIS  PULMONUM.)  The  reader  is  referred  to  P. 
L.  Tissier's  excellent  monograph  on  PXEUMO-THERAPY. 


370  MODKR.N   PHYSIO-THERAPY. 

Chancroid. — Copper-electrode  (positive)  should  be  ap- 
plied to  ulcer,  negative  pole  anywhere.  Galvanic  current 
should  be  applied  strong  and  long  enough  until  metallic  elec- 
trolysis is  complete,  which  is  shown  by  the  green  color  of 
the  cupric  oxychloride.  Negative  electrolysis  is  painful  and 
not  as  satisfactory.  Concentrated  chemical  rays  (Finsen) 
followed  by  thermic  rays  (Minin)  usually  produce  a  good 
result. 

Bubo. — (See  SEPSIS  and  SYPHILIS.) 

Chancre. —  (See  SYPHILIS.) 

Chilblains. — Positive  copper  electrode  locally,  negative 
sponge  electrode  elsewhere,  galvanism  three  to  five  minutes 
every  day  or  two,  ten  to  twenty  milliamperes.  Vibration, 
massage  and  heat  to  surrounding  parts. 

Chorea. — St.  Vitus'  dance  is  often  a  reflex  phenomenon 
and  may  be  due  to  dental  troubles,  worms,  eye-strain,  men- 
strual disturbances,  masturbation,  tight  foreskin,  etc.  Try 
to  find  the  cause  and  remove  it,  at  the  same  time  giving  the 
patient  the  benefit  of  rational  hygienic  treatment.  The  pa- 
tient should  be  kept  physically  and  mentally  quiet,  food 
should  be  non-stimulating  (vegetable),  the  bowels  should 
be  kept  open,  the  bladder-function  should  be  watched. 
General  eliminating  treatment  (sun-bath,  thermic  cylinder, 
electric-light  bath)  is  indicated  in  most  cases.  Galvaniza- 
tion (mild  current,  positive  to  occiput  and  down  spine,  nega- 
tice  to  feet)  is  useful.  Galvanic  warm  bath  (negative  in 
water,  positive  to  back  of  neck)  is  sometimes  employed. 
Static  (positive)  spray  to  head  and  spine  or  positive  static 
insulation  can  be  given  every  day  for  ten  minutes.  The 
general  high-frequency  treatment  in  the  diasolenic  cylinder 
is  very  effective.  Effleurage  over  stomach,  chest  and  back 
followed  by  resistance-movements  of  the  lower  extremities, 
with  the  patient  lying  down,  is  recommended  by  Busch, 
who  states  that  out  of  one  hundred  and  eight  patients  suf- 
fering from  chorea  and  treated  mechano-therapeutically  as 
indicated,  only  eight  were  not  relieved.  The  resistance- 
movements  have  a  fine  sedative  effect.  Some  of  the  choreic 


THERAPEUTIC  INDEX. 


371 


patients  suffer  from  rheumatism.     In  these  cases  massage 
and  sweat-baths  are  indicated. 

Colon -irrigation  is  ore  of  the  most  important  sanitary 
and  therapeutic  agents  in  the  treatment  of  most  diseases.  It 
is  administered  for  the  purpose  of  cleaning  out  the  large  in- 
testines. In  this  way  absorption  of  toxines  (auto-intoxica- 
tion) is  prevented  and  the  nerve-supply  of  the  abdominal 
organs  stimulated  through  the  solar  plexus,  which  is  not  in- 
frequently in  a  semi-paralytic  condition  from  the  pressure 


MI  XIX    REFLECTOR. 


of  a  distended  transverse  colon.  The  patient  is  placed  in 
the  knee-chest  position,  shoulders  down,  hips  elevated.  A 
well-greased  rectal  tube  is  now  introduced  up  to  or  beyond 
the  sigmoid  flexure  and  warm  water  from  a  fountain 
syringe  is  allowed  to  flow  through  the  rectal  tube  into  the 
descending  colon.  The  water  soon  fills  up  the  descending 
and  transverse  portions  of  the  colon  and  finds  its  way  into 
the  ascending  portion,  especially  if  the  patient  turns  on  his 
back  and  helps  in  the  distribution  of  the  water  by  firm 


372 


MODERN  PHYSIO-THERAPY. 


kneading  of  the  abdomen.  Colon-irrigation  is  not  usually  a 
success  the  first  time.  The  patient  may  complain  of  griping 
and  inability  to  hold  much  water.  With  each  succeeding 
attempt  less  difficulty  will  be  experienced  in  getting  water 
into  the  colon.  The  patient  should  persist  until  he  is  suc- 
cessful. The  effect  of  thorough  colon-irrigation  must  be 
experienced  in  a  number  of  cases  in  order  to  be  thoroughly 
appreciated.  In  the  treatment  of  chronic  diseases  its  value 
is  positively  inestimable. 


POSITION  OF  THE  BODY  FOR  COLON- 
IRRIGATION. 

Constipation  is  always  an  effect  of  some  pre-existing 
cause  and  as  such  secondary  to  the  condition  to  which  treat- 
ment should  be  directed.  Abstracting  from  purely  ex- 
traneous causes  which  may  produce  constipation,  e.  g.  the 
plumbism  of  lead- workers  and  the  habitual  use  of  opiates 
or  bismuth,  there  may  be  mechanical  reasons  why  the 
bowels  do  not  evacuate  their  contents  with  physiological 
regularity.  Such  mechanical  causes  are  malformations  of 
the  intestinal  canal,  malignant  or  cicatricial  strictures,  the 


THERAPEUTIC  INDEX.  373 

pressure  of  a  tumor  or  of  a  misplaced  or  enlarged  neigh- 
boring organ,  adhesions  involving  the  serous  coat  of  the 
intestines  and  the  presence  of  unusually  large  rectal  valves. 

The  causes  mentioned  are  of  comparatively  little  im- 
portance because  they  concern  but  a  small  percentage  of 
the  cases.  Heredity  is  a  questionable  etiological  element, 
although  some  authors  seem  to  attach  some  importance  to  it. 
In  keeping  with  the  causative  factors  which  are  at  fault  in 
the  vast  army  of  constipated  individuals,  especially  women, 
we  may  recognize  four  varieties  of  constipation,  to  wit: 
the  atonic,  the  neurotic,  the  metabolic  and  the  trophic  (die- 
tetic) form. 

Atonic  constipation  is  produced  by  and  associated  with 
atrophy  of  the  muscular  coat  of  the  intestines  and  a  coin- 
cident dilatation  of  the  bowels  (enterectasis)  and,  as  a  sub- 
sequent effect,  a*  dropping  of  the  vastly  dilated  intestines  out 
of  their  normal  position  (enteroptosis).  The  primary  etio- 
logical factor  in  these  cases  is  either  neglect  in  attending  to 
the  function  of  daily  defecation  or  the  existence  of  some 
form  of  gastric  dyspepsia  or  the  habitual  use  of  cathartic 
or  laxative  drugs. 

The  neurotic  form  of  constipation  is  coincident  with 
many  disorders  of  the  nervous  system,  notably  structural 
diseases  of  the  cord,  e.  g.  tabes.  Functional  disorders  of 
the  nervous  system,  including  the  almost  numberless  varie- 
ties of  neurasthenia  and  hysteria,  are  frequently  the  causa- 
tive factor. 

The  metabolic  variety  of  constipation,  as  the  name  in- 
dicates, is  coincident  with  and  produced  by  certain  disorders 
of  metabolism.  The  excessive  sweating  of  corpulent  and 
obese  persons  abstracts  moisture  from  the  tissues  of  the 
body  and  in  this  way  causes  the  fecal  matter  to  become  dry 
and  hard.  Anemia  frequently  produces  constipation  by  poor 
blood-supply  and  imperfect  nutrition  of  the  intestinal  walls. 
The  passive  congestion  often  associated  with  organic  dis- 
eases of  the  heart  and  lungs,  may  bring  about  a  constipated 
condition.  In  this  connection  it  may  be  of  interest  to  state 


374  MODERN  PHYSIO-TI:I-;R.\PY. 

that  dark-skinned  persons  are  more  frequently  constipated 
than  individuals  with  fair  skin.  Owing  to  the  absence  of 
pigment  in  the  latter  and  the  ready  entrance  of  actinic  sun- 
light, the  process  of  oxygenation  is  much  more  active  and 
general  nutrition  more  perfect. 

Trophic  (dietetic)  constipation  supervenes  in  persons 
whose  dietetic  habits  are  at  fault,  c.  g.  in  those  who  eat  an 
excess  of  meats.  This  phase  of  the  subject  is  illustrated  by 
the  notorious  constipation  of  the  carnivorous  animals  as 
contrasted  with  the  easy  and  copious  defecation  of  the  plant 
eaters. 

The  modern  treatment  of  constipation  may  be  presented 
under  the  head  of  the  various  psychic,  physiological  and 
mechanical  means  at  our  command. 

SUGGESTION. — That  the  control  of  mind  over  matter  re- 
fers in  no  uncertain  manner  to  the  defecatory  function,  is 
admitted  on  all  sides.  The  effect  of  a  powerful  and  suita- 
ble suggestion  given  by  the  medical  attendant  will  often 
manifest  itself  in  the  form  of  active  peristalsis  and  is  not 
infrequently  seen  in  the  action  of  a  bread-pill  which  the 
patient  takes  under  the  impression  that  a  strong  cathartic 
has  been  administered.  Concentrate  the  patient's  mind  on 
the  bowel- function  and  add  to  this  concentration  the  sug- 
gestion of  an  evacuation  to  occur  at  a  certain  time.  This 
frequently  paves  the  way  for  a  cure,  especially  in  neurotic 
subjects.  Encourage  the  patient  to  go  to  the  closet  at  a 
certain  time  every  day.  In  many  cases  the  auto-suggestion 
will  have  the  desired  effect,  if  the  patient  persists  in  the 
effort. 

DIET. — According  to  Boas,  diet  is  our  mainstay  in  the 
cure  of  constipation.  The  dietetic  directions  given  by  this 
author  enjoy  a  well-merited  reputation  in  Europe.  They 
represent  a  splendid  criterion  for  the  average  case.  Tell 
the  patient  to  drink  several  glasses  of  fresh  water  imme- 
diately after  risin^  in  the  morning.  In  some  cases  hot  water 
with  a  little  table-salt  seems  to  answer  better.  This  should 
be  followed  by  a  brisk  walk  in  the  open  air  for  not  less  than 


T::;.::.'.P::UT:C  IXECX.  375 

thirty  to  forty-five  minutes.  The  patient  is  now  ready  for 
his  breakfast,  which  should  consist  of  coffee  or  sweet  milk, 
oatmeal,  Graham-  or  rye-bread  and  plenty  of  fresh  fruit. 
Honey  should  take  the  place  of  butter  although  the  latter 
is  not  objectionable  in  the  majority  of  cases.  Sometimes  a 
breakfast  consisting  of  rye-bread  and  plenty  of  buttermilk 
is  relished  more  than  the  menu  given  above.  After  .the 
breakfast  the  patient  should  again  walk  for  fifteen  to  thirty 
minutes,  and,  following  this,  make  a  determined  effort  to 
defecate. 

The  midday  meal  should  consist  of  palatably  prepared 
vegetables  of  any  kind  (peas,  beans,  spinach,  cabbage,  etc.), 
rye-bread  and  butter,  and  plenty  of  fresh  or  cooked  fruit  of 
any  kind.  A  glass  of  light  wine  is  permissible.  Boas  al- 
lows the  patient  any  kind  of  meat  for  the  midday  meal.  The 
author  has  made  it  an  invariable  rule  to  exclude  meat  and 
has  never  had  occasion  to  change  his  ideas  on  this  subject. 
Man  was  originally  a  vegetarian.  Exclusion  of  meat  from 
his  diet  simply  means  a  return  to  the  original  natural  state. 
(See  chapter  on  DIETETICS.) 

The  evening  meal  should  consist  of  rye-bread  and  butter, 
milk  and  plenty  of  fresh  or  cooked  fruit.  Before  retiring  an 
apple  or  an  orange  might  be  allowed.  Fresh  buttermilk  is 
an  excellent  beverage  and  should  be  frequently  given  dur- 
ing the  day.  There  is  no  objection  to  fresh  water  during  or 
between  meals,  except  in  cases  of  well-marked  dilatation 
of  the  stomach  (atony,  gastrectasis)  in  which  the  drinking 
of  large  quantities  of  water  is  for  obvious  reasons  undesira- 
ble. There  is  no  objection  to  an  occasional  glass  of  light 
wine  or  beer,  preferably  ale,  especially  if  the  patient  is  in 
the  habit  of  indulging  in  stimulants  of  this  kind.  The  pa- 
tient should  not  be  allowed  more  than  one  or  two  cups  of 
coffee  throughout  the  day.  In  neurotic  cases  it  is  frequently 
advantageous  to  exclude  coffee  and  substitute  a  non-stimu- 
lating beverage.  In  regulating  the  diet  the  personal  equa- 
tion of  the  patient  must  not  be  lost  sight  of.  The  principal 
feature  should  be  the  enforcement  of  a  rigid  vegetable 


376  MODERN  PHYSIO-THERAPY. 

regime.  Fruit,  fresh  or  cooked,  is  by  all  odds  the  best  food 
for  most  patients  suffering  from  constipation.  Pure  cider 
is  hardly  ever  objectionable. 

IRRIGATION  OF  THE  COLON  is  an  agent  of  unquestioned 
value  in  all  cases  of  constipation.  It  should  be  practiced  two 
or  three  times  a  week  before  retiring.  The  apparatus  should 
consist  of  a  fountain  syringe,  to  the  nozzle  of  which  is  at- 
tached a  rectal  tube  or  a  good-sized  catheter,  which  is  in- 
troduced into  the  rectum  full  length.  The  water  should  be 
warm.  After  the  patient  has  received  fully  a  quart  or  more 
of  water,  he  should  lie  on  his  back  with  his  knees  drawn  up 
and  his  mouth  open.  Beginning  in  the  left  iliac  space  and 
following  the  course  of  the  descending,  transverse  and  as- 
cending portions  of  the  colon,  gentle  massage  should  be 
given  to  help  in  the  distribution  of  the  water  and  the  soften- 
ing up  of  the  fecal  matter.  (See  COLON  IRRIGATION,  FUNC- 
TIONAL DISORDERS  and  AUTO-INTOXICATION.) 

MASSAGE  OF  THE  ABDOMEN  is  useful  in  many  cases.  It 
should  be  given  three  times  a  week,  always  on  an  empty 
stomach.  If  the  physician  himself  is  not  an  adept  in  the  art 
of  massage,  it  is  best  to  either  desist  from  giving  it  or 
leave  this  part  of  the  treatment  to  one  who  is  familiar  with 
the  principles  and  practice  of  the  art.  The  manipulations 
should  be  deep  and  in  keeping  with  the  anatomical  structure 
of  the  intestinal  canal.  The  superficial  manipulations  of 
most  masseurs  and  masseuses  are  worthless  and  not  infre- 
quently irritating  to  the  skin  and  subcutaneous  tissues.  The 
value  of  a  well-fitting  abdominal  bandage  in  cases  of  gastric 
and  intestinal  dilatation  complicated  with  constipation  is 
worthy  of  mention.  In  constipated  persons  whose  abdom- 
inal wall  contains  a  thick  layer  of  adipose  tissue,  a  well- 
fitting  bandage  will  help  not  only  in  the  reduction  of  the 
"bay-window,"  but  also  in  the  cure  of  the  constipation. 
Cannon-ball  massage  by  the  patient  on  himself  is  not  infre- 
quently productive  of  good  results.  Wearing  an  anal  plug- 
dilator  of  suitable  size  often  relieves  constipation. 

EXERCISE   (active  and  passive)  is  an  essential  part  of 


THERAPEUTIC  INDEX.  377 

the  treatment.  Walking  is  good,  horseback  exercise  is  bet- 
ter. It  stimulates  metabolism  and  secures  for  the  organism 
the  untold  benefits  of  fresh  air  and  light.  The  so-called 
"Swedish  movements"  are  of  great  value.  Let  the  patient 
lie  down  on  his  back  and  slowly  rise  to  a  sitting  position  with 
his  arms  folded.  Let  him  slowly  return  to  the  dorsal  de- 
cubitus.  This  movement  should  be  repeated  twenty-five 
times  morning  and  evening.  The  firm  contraction  of  the 
abdominal  muscles  is  the  curative  agent  in  this  form  of  ex- 
ercise. The  latter  can  be  varied  by  letting  the  patient  stand 
and  slowly  bend  over  until  his  fingers  touch  his  toes.  There 
is  no  end  to  the  variety  of:  different  forms  of  active  and  pas- 
sive exercise  in  the  treatment  of  constipation.  In  some  cases 
of  constipation  characterized  by  extreme  gastric  and  enteric 
dilatation  and  a  general  collapse  of  the  nervous  system, 
the  enforcement  of  prolonged  rest,  as  suggested  by  Weir 
Mitchell  ("rest-cure")  is  not,  infrequently  of  great  benefit. 
The  art  of  applying  the  "rest-cure"  in  these  cases  consists 
in  knowing  when  the  physiological  moment  has  arrived  to 
substitute  stimulation  (exercise,  etc.)  for  enforced  rest. 

.HYDRO-THERAPY. — The  use  of  the1  cold  douche  or  pack 
on  the  abdomen  in  the  morning  is  very  useful,  especially  in 
persons  whose  circulation  is  good.  The  reaction  which  fol- 
lows tlie  douche  results  in  an  increase  of  arterial  blood  in 
the  abdomen  and  coincident  intensified  metabolism  and 
functional  activity  not  only  of  the  skin  but  the  intra-abdom- 
inal  lymphatics.  The  cold  douche  is  the  simplest  and  most 
useful  hydriatic  application  in  these  cases.  Much  will  de- 
pend on  a  physician's  power  of  individualization.  Much 
harm  is  sometimes  done  by  the  indiscriminate  use  of  cold 
water.  In  patients  whose  circulation  is  sluggish,  the  hot 
douche  or  warm  application  would  be  safer  than  the  use  of 
cold,  but  is  by  no  means  as  effective.  The  alternating  hot 
rnd  cold  douche  on  the  abdomen  is  a  splendid  local  tonic  in 
suitable  cases. 

ELECTRO-TTIKRAPY. — The  secondary  faradic  current,  ap- 
plied to  the  anterior  abdominal  wall  by  means  of  two  sponge- 


378  MoDKRX     I'llVSlO-TlIKKAl'V. 

electrodes  which  are  shifted  about  constantly,  is  a  simple  and 
useful  application.  Sometimes  it  is  of  advantage  to  place 
either  pole  on  the  back  and  the  other  pole  on  the  anterior 
abdominal  wall.  For  this  purpose  a  flat  abdominal  elec- 
trode is  useful.  This  form  of  faradization  can  be  com- 
bined with  abdominal  massage,  the  operator  holding  one 
sponge  in  one  hand  while  he  gives  massage  with  the  unen- 


THE  OSCILLATOR. 


gaged  hand,  the  patient  holding  the  other  sponge  in  one 
hand.  The  galvanic  current  is  frequently  useful.  A  rectal 
electrode  is  connected  with  the  positive  pole,  a  flat  abdom- 
inal electrode  being  attached  to  the  negative  side.  Rapid 
interruptions  by  means  of  rheotome  enhance  the  effect. 
Static  electricity,  both  in  the  form  of  a  negative  spray  applied 
to  the  abdomen  and  in  the  form  of  sparks  to  the  spine  and 
abdomen,  represents  a  valuable  addition  to  the  therapeutic 
means  at  our  command.  The  wave  current  applied  to  the 
abdomen  and  pushed  to  the  point  of  tolerance  acts  well  in 


THERAPEUTIC  INDEX.  379 

the  atonic  form  of  constipation.  In  the  neurotic  form  the 
various  kinds  of  high-frequency  currents  are  of  value  and 
frequently  bring  about  rapid  results  when  other  forms  of 
electricity  seem  to  be  without  avail. 

VIBRATION  AND  OSCILLATION. — Oscillation  enhances  the 
effect  of  massage  and  faradism.  The  different  varieties  of 
constipation  represent  probably  the  most  promising  field  for 
a  good  oscillator.  The  simplicity  of  technique  is  a  point  in 
its  favor.  Vibration  is  more  difficult  of  application,  but  a 
splendid  therapeutic  agent  in  the  hands  of  a  good  operator. 
The  application  should  be  made  peripherally  by  deep  and 
coarse  vibration  over  the  abdomen  in  the  direction  of  the 
peristaltic  movement.  Centrally  it  should  be  applied  by  deep 
and  rapid  strokes  to  the  lower  dorsal  and  upper  lumbar  ver- 
tebrae to  stimulate  the  centers  which  control  the  functions  of 
the  different  sections  of  the  intestinal  canal.  Vibration 
should  be  practiced  every  day  for  not  less  than  fifteen  min- 
utes. The  employment  of  rectal  vibration  by  means  of  a 
special  rectal  attachment  is  frequently  very  serviceable,  al- 
though in  many  instances  too  irritating  locally  to  be  of 
much  value. 

Speaking  collectively,  it  is  safe  to  say  that  the  best  and 
promptest  results  may  be  expected  in  cases  that  are  treated 
by  massage,  faradism,  galvanism  and  vibration.  Dietetic 
regulations  are  a  conditio  sine  qua  non  in  all  cases  of  con- 
stipation. (See  chapters  on  PERSONAL  HYGIENE:  and  DIE- 
TETICS.) 

Corns. — The  pain  of  a  corn  is  often  relieved  by  a  posi- 
tive static  brush  or  spray.  A  positive  galvanic  current 
locally  is  useful. 

Cough. — Inasmuch  as  cough  is  always  a  symptom,  its 
management  can  not  be  separated  from  the  treatment  of 
the  cause.  As  a  means  of  excretion  it  is  salutary  in  char- 
acter, e.  g.  in  cases  of  pneumonia,  bronchitis,  tuberculosis, 
etc.  It  is  only  when  the  cough  is  dry,  incessant,  distressing 
and  seemingly  uncalled  for  and  ineffective  that  measures 
should  be  adopted  to  relieve  and,  if  possible,  remove  it. 


380  MODERN  PHYSIO-THERAPY. 

REFLEX  COUGH. — Cough  may  be  produced  by  irritation 
of  the  pneumogastric  and  phrenic  nerves  in  cases  of  heart- 
trouble,  dyspepsia,  diseases  of  the  liver,  tumors  or  inflam^ 
matory  swellings  pressing  on  and  irritating  the  nerves 
named.  Displacements  and  other  abnormal  conditions  in 
the  cervical  spine  may  cause  cough.  The  abdominal  vis- 
cera, especially  the  internal  sexual  organs  of  women  may, 
by  irritation  of  their  nerve-supply,  set  up  cough,  the  irri- 
tating impulse  being  carried  by  sub-plexus  and  sub-ganglia 
to  the  solar-plexus,  nerves  of  the  stomach,  liver  and  dia- 
phragm and  finally  to  the  respiratory  nerves  (e.  g.  morning 
cough  of  drinkers).  Vibration  over  the  lower  cervical  and 
upper  dorsal  vertebrae,  together  with  faradization  or  galvan- 
ization of  the  vagus  is  very  useful.  It  is  plain  that  treat- 
ment of  the  cough  must  at  all  time's  be  secondary  to  the 
treatment  and  removal  of  the  cause. 

CONGESTIVE  COUGH. — It  is  associated  with  and  produced 
by  inflammatory.1  congestive  or  catarrhal  conditions  of  any 
part  of  the  respiratory  mechanism  (bronchitis,  pneumonia, 
etc.)..  In  addition  to  treating  the  underlying  cause,  the 
cough  can  be  relieved  by  inhalations  of  vapor,  warm  appli- 
cations to  the  chest  and  depleting  hydro-therapeutic  appli- 
cations to  the  feet.  Exposure  to  electric  light  (local  ap- 
paratus) is  useful.  Cold  douches  to  the  cervical  spine  fre- 
quently relieve  congestive  cough,  especially  in  old  catarrhal 
cases.  If  the  cough  is  moist,  i.  e.  a  means  of  excretion,  it 
should  not  be  interfered  with. 

NERVOUS  COUGH. — It  differs  from  the  first  named 
variety  by  being  apparently  independent  of  any  pathological 
condition  in  any  part  of  the  organism.  It  is  produced  by 
psychic  or  temperamental  causes.  Cases  of  this  kind  are 
hard  to  handle.  Suggestion  sometimes  does  good.  Static 
spray  on  the  spine  can  be  tried  as  a  suggestive  agent. 

MECHANICAL  COUGH. — It  is  due  to  foreign  bodies  in  the 
air-passages,  inhalation  of  irritating  vapors,  gases  and 
other  substances  and  may  be  caused  by  an  elongated  uvula. 
Injudicious  ozone-inhalation  sometimes  produces  a  most 


THERAPEUTIC  INDEX.  381 

distressing  and  stubborn  cough  of  this  kind.     Treatment 
in  all  these  cases  depends  on  the  cause. 

SYSTEMIC  COUGH. — It  is  due  to  constitutional  disease  of 
some  kind,  e.  g.  rheumatism,  gout,  plethora,  syphilis.  It 
is  an  evidence  of  auto-intoxication  and  can  not  be  cured  un- 
less the  cause  is  removed. 

LARYNGEAL  COUGH. — It  is  characteristic  on  account  of 
its  metallic  intonation  and  is  produced  by  pertussis,  inflam- 
mation of  the  larynx,  disease  of  the  laryngeal  structures, 
aortic  aneurism,  mediastinal  tumors  and  other  conditions 
irritating  the  recurrent  laryngeal  nerve.  Positive  electricity 
(galvanic,  static)  applied  directly  to  the  larynx  frequently 
acts  as  a  sedative. 

Cough  is  never  a  disease  per  se  and  for  this  reason  the 
etiological  factor  must  be  sought  for  and  treatment  given 
accordingly.  Some  of  the  unsuspected  causes  of  unac- 
countable cough  are  dilatation  of  the  stomach,  worms,  con- 
stipation, tight  prepuce,  menstrual  disorders,  hemorrhoids 
and  locomotor  ataxia.  Try  to  find  the  cause  in  keeping  with 
the  classification  given  above  and  treat  accordingly. 
'Cirsoid  Aneurism. —  (See  VASCULAR  TUMORS.) 

Cicatrices. — Negative  electrolysis. 

Cystitis. — The  acute  attack  requires  rest,  open  bowels, 
hot  applications  over  pubic  region  and  perineum,  hot  rectal 
injections,  derivating  packs  to  the  abdomen  and  lower  ex- 
tremities, drinking  of  water  in  copious  quantities  and  a  mild 
vegetable  or  milk  diet.  (See  INFLAMMATION  ( ACUTE)  and 
FEVER.  ) 

Chronic  inflammation  of  the  bladder,  in  addition  to  the 
directions  given  above,  requires  the  use  of  clear  warm 
water  for  irrigation.  Locate  the  cause  of  the  bladder-ca- 
tarrh and  try  to  remove  it. .  ( See  INFLAMMATION, 
CHRONIC.)  Locally  galvanism  (positive  over  the  bladder, 
negative  on  the  back),  positive  static  spray  or  high-fre- 
quency current  might  be  used.  Vibration  over  the  lumbar 
vertebrae  helps  to  regulate  the  local  circulation.  Local  elec- 


382  MoDKKX     PllYSIO-TlIKKAPY. 

trie-light  bath  is  beneficial,  followed  by  a  vapor  sitz-bath. 
In  cases  of  non-inflammatory  irritable  bladder  weak  faradic 
secondary  current  applied  in  or  near  the  bladder,  negative 
to  abdomen,  also  galvanic  (positive  over  pubes,  negative  to 
feet,  ten  milliamperes  ten  to  twenty  minutes  every  day) 
are  useful. 

Dandruff. — Improve  the  nutrition  of  the  scalp  by  hot 
water,  high  frequency  applications  (daily  for  15  minutes) 
and  negative  indirect  static  sprays  (daily  for  10  minutes). 
Expose  scalp  to  fresh  air  and  sunlight  as  much  as  possible. 
Clipping  the  hair  is  frequently  of  advantage.  The  general 
condition  should  not  be  lost  sight  of.  See  SKIN  DISEASES. 

Deafness. — Pneumatic  massage  by  means  of  a  special 
pump-device  operated  by  an  electric  motor  is  serviceable  in 
catarrhal  deafness.  If  the  case  is  recent,  some  good  might 
be  done  by  the  use  of  dry-heat  (Hopkins'  device).  Cala- 
phoresis  of  potassium  iodide  is  advised  by  some.  Pack  audi- 
tory canal  with  cotton  soaked  in  saturated  solution  of  K  I. 
Attach  to  negative  pole  of  weak  galvanic  current  for  ten 
minutes  every  other  day,  positive  pole  on  opposite  shoulder. 
In  neurotic  deafness  use  high-frequency  current  with  ear 
vacuum-electrode.  Pack  ear  with  wet  cotton  and  apply 
positive  pole  of  galvanic  current,  negative  on  opposite 
shoulder,  three  to  five  milliamperes  for  five  to  ten  minutes 
every  day  or  two.  Vibration  over  mastoid  is  useful  in  some 
cases. 

Derivation  is  the  act  of  depleting  one  part  by  drawing 
or  forcing  the  blood  into  other  part.  Theory  and  practice 
of  derivation  are  discussed  in  the  chapter  on  THE  THERA- 
PEUTIC EFFECTS  OF  HEAT  AND  COLD. 

Diabetes  Insipidus. — Ideal  hygienic  surroundings  and 
the  enforcement  of  every  detail  of  personal  hygiene  are  the 
prime  conditions  of  treatment.  Colon-irrigation  should  be 
practiced  in  every  case.  The  diet  should  include  nitrog- 
enous and  carbo-hydrate  foods  to  suit  the  palate  and  stom- 
ach of  the  individual  patient.  Fats,  too  much  meat,  spices, 
highly  seasoned  foods,  pastry  and  very  rich  articles  of  food 


THERAPEUTIC  INDEX.  383 

are  objectionable.  For  general  regime  and  symptomatic 
therapy  see  DIABETES  MELLITUS.  The  galvanic  bath  (pos- 
itive in  water,  negative  to  back  of  neck)  is  often  beneficial. 

Diabetes  Mellitus. — The  management  of  a  case  of  dia- 
betes is  largely  a  hygienic  and  dietetic  problem.  The  dis- 
ease is  probably  the  result  of  a  disturbance  in  the  nervous 
mechanism  which  controls  metabolism.  The  hygienic 
therapy  should  include  everything  that  is  likely  to  regulate 
the  organic  functions.  Fresh  air  at  all  times,  sun-baths  as 
often  as  possible,  open  emunctories  and  freedom  from  men- 
tal and  physical  strains  of  any  kind  are  the  elementary  con- 
ditions of  treatment.  The  skin  should  be  kept  active  by  two 
eliminative  baths  or  packs  a  week,  followed  by  a  brisk  dry 
rub-down.  A  Priessnitz  compress  to  the  abdomen  at  night, 
followed  by  cold  sponge-bath  in  the  morning,  should  be 
habitually  resorted  to.  Colon-irrigation  is  advisable  every 
other  day.  Deep  massage  of  the  muscles  of  the  extremities 
and  resistance-movements  of  the  same  have  a  tendency  to 
improve  general  health.  Later  on  systematic  gymnastic  ex- 
ercises should  be  prescribed,  preferably  in  the  open  air  to 
enhance  oxygenation  of  the  blood. 

The  diet  of  a  diabetic  patient  demands  the  exclusion  of 
sugar  and  starches.  According  to  most  authors  a  strongly 
nitrogenous  diet  is  indicated.  Townsend's  dietetic  direc- 
tions for  diabetes  include  all  varieties  of  meat,  such  as  beef, 
veal,  mutton,  fowl,  game,  pork,  tongue,  brain,  sweetbread, 
kidneys,  marrow  of  bones,  cured  meats,  fresh  fish,  shell- 
fish, preserved  fish,  also  oils,  eggs,  milk,  cheese,  nuts  except 
chestnuts,  endives,  spinach,  beans,  peas,  onions,  leek,  as- 
paragus, cabbage,  meat-soups  without  sugar  or  flour.  Fats 
and  oils  are  especially  useful.  Lettuce  has  from  time  im- 
memorial enjoyed  the  reputation  of  being  almost  a  specific 
in  diabetes.  This  is  a  popular  belief  concerning  what  is 
certainly  a  splendid  restorative  for  diabetics.  Weak  coffee 
without  sugar  is  permissible.  Alcohol  and  tobacco  are 
strictly  interdicted. 

The  patient,  according  to  most  authors,  must  positively 


384  MODERN  PHYSIO-THERAPY. 

abstain  from  ordinary  bread,  sugar,  jelly,  sweetmeats,  pas- 
try, ice-cream,  sweet  wines,  sweet  fruit,  cereals,  starches  of 
any  kind,  potatoes  and  honey. .  Gluten  and  bran-bread,  with- 
out the  starch  of  flour,  are  permissible. 

Libraries  have  been  written  on  the  subject  of  diet  for 
diabetics.  The  prominence  which  is  given  to  meat  is  open 
to  criticism.  Nature  frequently  inhibits  the  forced  meat- 
diet  by  causing  the  patient  to  experience  a  well-marked 
nausea  at  the  very  sight  of  meat.  A  moderate  meat  diet 
seems  to  meet  the  indications  much  better.  The  objections 
to  bread  seem  to  be  ill-founded  because  most  diabetics  crave 
wheat-bread  and  thrive  on  it.  Green  vegetables  are  always 
permissible.  The  preponderance  of  fats  and  oils  in  a  dia- 
betic patient's  diet  is  of  doubtful  propriety.  Vegetable  fats 
are  a  splendid  food  for  diabetics.  The  marrow  of  the  co- 
coanut  yields  a  fat  (oleum  cocois)  which,  according  to 
Liebig  and  Fresenius,  does  not  contain  fatty  or  mineral 
acids  and  seems  destined  to  serve  as  a  food  of  greatest  value, 
It  has  been  found  very  serviceable  in  the  dietetic  manage- 
ment of  diabetes  mellitus.  Alcohol  is  not  altogether  without 
value  in  these  cases.  A  glass  or  two  of  fine  old  Rhine  or 
Moselle  wine  daily  may  be  allowed,  especially  if  the  patient 
is  accustomed  to  alcoholic  stimulation. 

The  enforcement  of  active  exercise,  supplemented  by 
massage,  daily  baths,  cold  douches  to  the  back  and  thighs, 
is  of  overtowering  importance  because  metabolism  and  oxi- 
dation must  be  stimulated  at  all  hazards.  The  thermic  cylin- 
der and  the  vapor-bath  can  be  advantageously  employed. 
Excessive  weakness,  a  tendency  to  fainting  and  cerebral 
symptoms  are  centra-indications  to 'the  employment  of  too 
active  elimination  through  the  skin.  The  object  of  all  thera- 
peutic agents  in  this  disease  should  be  to  improve  general 
health  and  prevent  loss  of  weight. 

Vibration  of  the  muscles  of  the  extremities  and  also  over 
the  dorsal  vertebrae  is  frequently  of  benefit.  A  daily  high- 
frequency  treatment  in  the  diasolenic  cylinder  or  in  D'Ar- 
sonval's  cage  is  a  most  useful  adjunct  to  the  treatment.  The 


THERAPEUTIC  INDEX.  385 

wave-current  applied  to  the  entire  spine  and  over  the  lumbar 
region  has  been  found  serviceable.  A  static  insulation  or  a 
negative  crown-breeze  is  often  beneficial.  The  value  of  the 
arc-light  bath  can  not  be  overrated.  Symptomatic  therapy 
is  often  necessary  to  meet  special  features  of  diabetic  cases. 
(See  FUNCTIONAL  DISORDERS  and  REFLEX  DISORDERS.) 

Diarrhea  may  be  due  to  the  presence  of  irritating  sub- 
stances in  the  alimentary  canal  and  is  the  effort  made  by 
nature  to  eliminate  the  offensive  material.  It  may  be  due  to 
impaired  innervation  of  the  bowels  or  to  inflammatory  con- 
ditions in  the  intestinal  canal.  Sometimes  it  co-exists  and 
is  directly  connected  with  certain  general  diseases  (Bright's 
disease,  cancer,  diabetes)  and  represents  nature's  eliminative 
efforts. 

As  long  as  the  stools  are  offensive,  the  diarrhea  is  salu- 
tary and  should  not  be  interfered  with.  High  injections 
(colon-irrigation)  should  be  given  for  the  purpose  of  dilut- 
ing the  deleterious  material  and  facilitating  its  discharge. 
To  enforce  rest  of  the  intestinal  coats  the  patient  should  ab- 
stain from  food  entirely  for  a  day  or  two  or  even  longer. 
Theje  is  no  better  way  of  compelling  the  organism  to  ab- 
sorb inflammatory  material  than  by  suspending  the  function 
of  food-assimilation.  The  three  remaining  emunctories 
(skin,  lungs,  kidneys)  assume  the  task  of  normal  excretion 
and  exercise  their  activity  in  a  compensatory  way.  Aug- 
mented skin-function  (dry-heat  cylinder,  electric-light  bath) 
abstracts  fluids  from  the  alimentary  canal  and  counteracts 
the  tendency  towards  too  frequent  and  copious  evacuation. 
Colon-irrigation  by  means  of  starch-water  can  be  used  after 
the  acute  stage  is  over.  Locally  hot  applications  over  the 
abdominal  wall  are  serviceable.  A  positive  static  insulation 
has  a  general  sedative  effect  and  enhances  the  action  of 
the  therapeutic  measures  names.  On  the  second  or  third 
day  the  patient  can  be  fed  to  light  articles  of  food.  (See 
GASTRITIS.)  If  diarrhea  is  a  concomitant  symptom  or 
phenomenon  of  some  constitutional  malady,  the  latter  should 
receive  proper  attention.  During  the  convalescence  after 


386  MODERN  PHYSIO-THERAPY. 

an  attack  of  diarrhea,  alcoholic  stimulants  (red  wine,  claret, 
port)  serve  an  excellent  purpose.  The  regime  outlined  ap- 
plies to  the  acute  as  well  as  the  chronic  form  of  the  disease. 

Diet  in  Acute  Fevers. — To  establish  the  proper  propor- 
tion between  the  rapidly  oxidizing  tissue-consumers  and  the 
needed  tissue-builders,  the  latter  should  be  given  in  relative 
excess.  To  facilitate  digestion  and  assimilation,  liquid  or 
semi-liquid  food  is  preferable  to  solid  food.  In  all  acute 
fevers  soups  and  broths  should  constitute  an  important  part 
of  the  diet.  Beef-broth,  mutton-broth,  chicken-broth,  veg- 
etable soup,  beef-tea  can  be  given  in  small  quantities  at  a 
time.  In  the  manner  of  preparation  and  serving,  it  is  of  ad- 
vantage to  please  the  eye  and  the  palate  of  the  patient.  Milk, 
hot  or  cold,  with  or  without  lime-water,  properly  prepared 
rice-water,  barley-water,  very  soft  oatmeal,  rice,  a  soft- 
boiled  egg,  milk-toast,  eggnog,  buttermilk,  soaked  crackers, 
gruel,  white  of  egg  beaten  up  in  barley-water,  offer  a  plen- 
tiful variety  to  choose  from.  In  typhoid  fever  solid  food  is 
particularly  objectionable  on  account  of  the  ulcerated  con- 
dition of  the  intestines.  Fever-cases  should  be  fed  fre- 
quently with  a  small  amount  of  food  at  a  time.  A  point 
which  is  of  importance  and  usually  neglected  is  the  hygiene 
of  the  mouth  in  fever-cases.  Before  and  after  every  meal  or 
feeding,  a  fever-patient  should  be  given  a  chance  to  cleanse 
the  oral  cavity,  especially  the  lips  and  the  teeth.  If  the 
patient  is  unable  to  do  this,  the  attendant  should  do  it  for 
him.  Clear,  lukewarm  water  answers  very  well.  Clear, 
cool  drinking-water  should  always  be  freely  allowed  in  all 
fever-cases. 

Drug-habits. — In  all  but  advanced  cases  the  use  of  the 
drug  should  be  stopped  abruptly.  It  is  by  all  odds  better 
to  let  a  patient  fight  it  out  until  nature  comes  to  his  rescue. 
In  the  meantime  his  general  health  should  be  improved  by 
general  massage,  spinal  vibration  and  different  kinds  of 
water-applications.  If  patient  has  lost  much  in  weight,  al- 
low a  rich,  nitrogenous  diet  provided  the  stomach  will  stand 
it.  Fresh  air,  sunlight,  active  exercise  and  open  bowels 


THERAPEUTIC  INDEX.  387 

should  be  insisted  upon.  The  electric-light  bath  is  very 
useful  in  most  of  these  cases.  In  extreme  cases  no  general 
directions  can  be  given.  All  cases  of  drug-addiction  ought 
to  be  treated  in  an  institution  equipped  for  this  purpose. 

Drugs. — The  idea  that  drug-methods  and  physio-thera- 
peutic methods  can  be  indiscriminately  combined  to  mutually 
assist  and  supplement  each  other,  is  not  unconditionally  cor- 
rect in  principle  and  might  prove  disastrous  in  practice. 
Drugs  that  are  likely  to  upset  the  stomach,  that  disturb 
metabolism  and  are  accumulative  in  their  action,  should 
never  be  given  when  physio-therapeutic  methods  are  fol- 
lowed. Patients  that  are  taking  salicylates,  iodides,  digi- 
talis, pilocarpine,  mercury,  or  worm-medicines  should  not 
be  treated  in  the  dry-heat  cylinder,  the  electric-light  bath  or  * 
general  pack,  unless  the  dose  of  the  drug  taken  has  been 
very  small.  The  action  of  saline  laxatives  is  much  en- 
hanced by  massage  and  vibration  of  the  stomach.  The  en- 
forcement of  a  strictly  vegetable  diet  makes  a  patient  more 
susceptible  to  all  drugs  that  affect  the  circulation  and  meta- 
bolism. The  doses  of  these  drug-agents  should  be  corre- 
spondingly reduced.  The  dehydration-method  of  Oertel  is 
incompatible  with  digitalis  or  arsenic.  (See  VALVULAR 
DISEASES  OF  THE;  HEART.)  Massage,  Swedish  movements 
and  vibration  are  of  uncertain  value  if  the  patient  is  taking 
mercury  in  specific  doses.  Patients  who  are  taking  bro- 
mides should  not  be  treated  with  static  electricity,  especially 
if  they  are  of  a  neurotic  temperament.  High-frequency  cur- 
rents applied  by  means  of  vacuum-electrodes  are  very  irri- 
tating if  the  patient  is  taking  Fowler's  solution.  I  have  seen 
a  true  dermatitis  develop  in  more  than  one  case  of  this  kind. 
The  physician  should  never  forget  that  dry-heat,  electric- 
light  and  hydro-therapeutic  treatment  affect  metabolism  so 
markedly  and  deeply  that  the  administration  of  drug-agents 
becomes  an  entirely  new  proposition.  So-called  therapeutic 
doses  become  poisonous  doses  under  these  circumstances. 
Even  the  character  of  the  drug-action  might  change.  The 


MODERN  PHYSIO-THERAPY. 


statements  made  are  based  upon  a  varied  experience  along 
these  lines. 

Dysentery. — The  treatment  of  the  acute  form  of  the 
disease  consists  in  rest,  diet,  irrigation  and  other  therapeutic 
measures,  outlined  under  the  head  of  DIARRHEA.  Absolute 
cleanliness  about  the  person  of  the  patient,  the  bed  and  the 
room  is  necessary  on  account  of  the  infective  character  of 
the  dysenteric  discharges. 

The  treatment  of  chronic  dysentery  is  identical  with  that 
of  chronic  diarrhea.  Starch-water  irrigations  and  the  use 
of  alum  and  other  astringents  are  indicated  in  the  ulcerative 
form  of  the  disease.  Hot  water  per  rectum  is  a  splendid 
anodyne  in  some  cases.  In  other  cases  cold  water  seems  to 
be  more  effective.  Alcoholic  stimulants  in  small  doses  are 
indicated  in  most  cases  of  chronic  dysentery  (red  wine, 
port  wine). 

Dysmenorrhea. — If  it  is  due  to  obstruction  of  the  cerv- 
ical canal,  follow  directions  given  under  STENOSIS.  If  it  is 
the  result  of  a  co-existing  inflammation  or  catarrh  of  the 
body  or  neck  of  the  uterus,  treat  the  cause.  In  the  mem- 
branous form  of  dysmenorrhea  use  a  galvanic  current 
(twenty  to  sixty  milliamperes,  negative  pole  in  uterus,  posi- 
tive pole  on  abdomen,  for  ten  minutes  every  third  day,  be- 
ginning ten  days  before  the  menstrual  period).  If  patient 
is  a  virgin,  place  positive  on  back,  negative  on  pubes, 
twenty  milliamperes,  ten  minutes  every  other  day.  Let  pa- 
tient sit  in  a  lukewarm  bath  (water  carrying  a  mild  negative 
galvanic  current).  Static  positive  insulation  and  negative 
breeze  to  back  are  useful.  Faradization  (one  pole  over 
pubes,  the  other  on  lumbar  region,  weak  current  every  other 
day  for  fifteen  minutes)  sometimes  prevents  an  attack. 
For  additional  therapeutic  directions  see  AMENORRHEA. 
The  dry-heat  cylinder  can  often  be  advantageously  em- 
ployed in  cases  of  dysmenorrhea. 

Dyspepsia  (Chronic). — Dyspepsia  in  its  various  forms 
is  the  classical  type  of  a  chronic  disease.  It  is  the  most 
common  of  all  chronic  diseases  and  surpasses  in  point  of 


THERAPEUTIC  INDEX. 


389 


symptomatic  variety  any  or  all  other  diseases.  Among  the 
chronic  cases  that  go  from  one  doctor  to  another  without 
getting  much  relief,  the  various  forms  of  apparent  or  dis- 
guised stomach  trouble  represent  by  far  the  largest  per- 
centage. It  is  especially  the  disguised  forms  of  gastric  dis- 
order that  are  very  much  in  evidence  without  their  presence 
even  being  suspected.  The  stomach  is  the  dog  in  the  man- 
ger. Many  a  patient  who  is  being  treated  for  nervousness, 
hysteria,  neurasthenia,  hypochondriasis,  insomnia,  headache, 
muscular  rheumatism,  neuralgia,  imperfections  of  sight, 


THE  HYDRO-ELECTRIC  BATH. 


vertigo,  heart-trouble,  eczema  and  many  other  forms  of  skin 
disease,  is  a  dyspeptic  and  can  not  get  well  because  the  dys- 
peptic condition  remains  unsuspected,  unattended  and  un- 
improved. Physiological  therapy  has  taught  us  to  go  back 
to  the  cause,  the  actual  and  primary  reason  for  any  existing 
condition.  We  are  not  satisfied  to  make  a  symptomatic 
diagnosis  at  any  time.  Any  layman  who  has  a  smattering 
of  medical  terms  can  make  a  diagnosis  of  lumbago,  sciatica, 
vertigo  or  chronic  eczema.  The  physician  who  is  satisfied 
with  this  kind  of  a  diagnosis  could  reasonably  not  be  ex- 
pected to  do  any  more  for  his  patient  than  to  prescribe  the 


390  MODERN  PHYSIO-THERAPY. 

stereotyped  salicylates,  iodides,  bromides  and  salves.  The 
diagnosis  and  the  treatment  are  on  a  par.  They  are  un- 
worthy of  the  name.  The  modern  physician  wants  to  know 
the  reasons  for  certain  symptoms.  He  evolves  the  treatment 
from  the  etiology  and  adapts  it  to  the  pathological  and 
symptomatic  picture  presented  by  the  individual  case. 

The  term  "dyspepsia"'  expresses  difficulty  in  the  per- 
formance of  gastric  digestion.  Inasmuch' as  gastric  diges- 
tion is  a  most  important  phase  in  the  process  of  nutrition 
(anabolism),  it  is  directly  related  to  the  well-being  of  the 
whole  organism  and  all  its  parts.  If  gastric  digestion  is  dis- 
turbed, the  functional  activity  of  the  intestinal  canal,  espe- 
cially the  small  bowels,  is  usually  impaired  at  the  same  time. 
In  other  words,  gastric  indigestion  does  not  usually  exist 
without  some  impairment  of  intestinal  digestion.  That  the 
existence  of  dyspepsia  should  manifest  itself  in  a  thousand 
different  ways,  is  not  surprising.  Any  part  of  the  organism 
might  give  evidence  of  malnutrition,  auto-intoxication  and 
resulting  functional  impairments.  The  effects  of  dyspepsia 
might  manifest  themselves  at  some  point  of  least  resistance 
and  might  be  modified  by  the  peculiarities  and  idiosyncracies 
of  the  individual  organism.  Thus  we  can  explain  the  kalei- 
doscopic variety  of  symptoms  that  the  individual  case  might 
present.  These  symptoms  might  be  suggestive  of  stomach 
trouble  (by  directing  the  attention  of  the  medical  attendant 
to  the  stomach)  or  misleading  (by  appearing  in  some  part 
or  structure  apparently  in  no  connection  with  the  stomach, 
e.  g.  in  many  cases  of  sciatica  and  numerous  neuroses).  Re- 
member once  for  all  that  in  cases  of  chronic  rheumatism, 
neuralgia  and  neuroses,  skin  diseases  and  in  the  endless 
chain  of  disorders  of  the  liver  and  bowels,  you  can  always 
win  half  the  battle  and  frequently  the  whole  if  you  know 
how  to  handle  the  stomach.  The  symptomatology  of  dys- 
pepsia is  unlimited  because  the  stomach  is  the  most  im- 
portant organ  of  nutrition.  Impairment  of  its  function 
may  mean  malnutrition  of  the  whole  organism  or  of  some 
special  part  or  region.  Through  the  nervous  system,  es- 


THERAPEUTIC  INDEX.  391 

pecially  the  vaso-motors,  the  gastric  trouble  may  be  re- 
flected to  some  distant  part,  apparently  in  no  way  con- 
nected with  the  actual  cause  of  the  trouble.  Through  the 
pneumogastric  and  phrenic  nerves,  the  diseased  stomach 
may  cause  symptoms  on  the  part  of  the  diaphragm,  the 
heart  and  the  respiratory  apparatus.  Continued  pressure 
of  a  dilated  stomach  posteriorly  may  cause  inhibition  of 
the  function  of  the  numerous  nerves  that  form  the  closely 
communicating  and  vastly  ramifying  network  of  the  solar 
plexus  and  the  ten  smaller  plexus  that  spring  from  it. 
In  this  way  the  structure  and  function  of  all  the  abdominal 
viscera  may  be  more  or  less  seriously  impaired.  (See 
FUNCTIONAL  DISORDERS  and  REFLEX  DISORDERS.)  Con- 
stipation is  usually  present.  There  is  no  end  to  the  chain 
of  reflex  symptoms  that  are  liable  to  be  produced  by  a 
dilated  stomach  and  may  deceive  the  physician  in  regard 
to  the  true  natvire  of  his  patient's  ailment. 

If  you  have  a  case  of  any  chronic  disease  that  has  stub- 
bornly resisted  all  attempts  at  treatment,  give  that  patient 
the  benefit  of  the  doubt  and  make  a  provisional  diagnosis  of 
dilatation  of  the  stomach.  It  is  the  condition  that  has  been 
variously  called  catarrh  of  the  stomach,  atony  of  the  stom- 
ach, gastrectasis,  chronic  dyspepsia,  etc.  If  your  patient 
habitually  has  a  coated  tongue,  let  him  lie  down  with  the 
knees  drawn  up  and  the  diaphragm  relaxed  (mouth  open). 
If  palpation  of  the  epigastrium  causes  distress  or  discomfort, 
or  if  you  can  cause  the  stomach  to  give  evidence  of  the 
presence  of  gas  and  water  (gurgling,  splashing,  succus- 
sion),  the  diagnosis  is  complete.  An  examination  of  this 
kind  should  be  made  on  an  empty  stomach. 

The  objection  might  be  raised  that  the  term  dyspepsia 
is  not  suggestive  of  any  well-defined  pathological  condi- 
tion, but  rather  of  an  impairment  of  function  which  might 
be  due  to  and  co-existent  with  any  number  of  conditions. 
When  we  remember  that  all  subdivisions  and  varieties  of 
functional  diseases  of  the  stomach  are  due  to  the  same 
cause,  to  wit ;  disturbance  of  nutrition  of  the  stomach  as  an 


392  MODERN  PHYSIO-THERAPY. 

organ,  it  becomes  clear  that  the  above  objection  does  not 
hold  good.  As  long  as  the  circulation  in  the  walls  of  the 
stomach  is  physiologically  normal,  the  function  of  these 
walls  and  of  the  several  functionating  structures  contained 
in  them  must  necessarily  be  physiologically  perfect.  We 
know  that  the  circulation  is  regulated  by  the  sympathetic 
(trophic,  vaso-motor)  nerve-supply  and  that,  in  turn,  the 
function  of  the  nerves  depends  upon  their  blood-supply. 
Thus  we  can  readily  see  the  close  relative  connection  which 
exists  between  the  nervous  system  and  the  stomach.  Thus 
we  can  understand  why  nerve-disorders,  psychoses,  neu- 
roses, etc.,  are  likely  to  be  closely  associated  with  disorders 
of  the  stomach  and  why,  in  turn,  stomach  disorders  are 
liable  to  manifest  their  presence  through  reflex  nervous 
phenomena.  It  makes  no  practical  difference  in  the  erad- 
ication of  the  cause  whether  there  is  hyper-acidity,  absence 
of  ferments  or  any  other  subvariety  of  gastric  indigestion. 
All  these  conditions  are  results,  not  causes  nor  patholog- 
ical states  per  se.  There  is  absence  of  tone  in  the  walls  of 
the  stomach,  due  to  changes  in  the  nutrition  (circulation) 
in  the  walls  or  exhaustion  of  the  nerve-supply  of  the  stom- 
ach, resulting  in  a  weak  condition  and  flabby  state  of  the. 
muscular  coat.  The  varieties  of  dyspepsia  are  results 
thereof.  This  is  the  clinical  meaning  of  dyspepsia.  If  the 
condition  continues  for  a  long  time,  it  produces  atrophy 
of  the  muscular  coat,  venous  hyperemia  of  the  mucosa  and 
proliferation  of  connective  tissue.  The  stomach  becomes 
baggy,  flabby,  atonic.  It  loses  the  power  of  expelling  the 
gaseous  products  of  fermentation.  Thus  the  stomach  be- 
comes dilated.  For  this  reason  we  look  upon  some  degree 
of  dilatation  of  the  stomach  as  being  associated  with  and 
necessarily  consequent  upon  all  forms  of  chronic  dys- 
pepsia. 

How  can  we  treat  and  cure  a  case  of  dyspepsia,  using 
the  term  "dyspepsia"  in  the  sense  indicated  ?  The  local 
treatment  consists  in  massage,  vibration,  electricity,  diet 
and  colon-irrigation.  The  general  treatment  should  aim  at 


THERAPEUTIC  INDEX.  393 

stimulating  and  correcting  metabolism.  For  this  purpose 
the  employment  of  superheated  air  and  high-frequency 
currents  is  indicated. 

MASSAGE. — The  immediate  effect  of  manipulation  of  the 
stomach  is  the  production  of  active  hyperemia.  The  epi- 
gastrium is  warmed  up,  the  blood-supply  of  the  stomach 
and  the  continuuous  structures  are  changed  by  the  afflux 
of  fresh  arterial  blood  and  the  consequent  depletion  of  the 
veins,  the  absorbent  glands  are  stimulated,  the  walls  of  the 
stomach  and  transverse  colon  eventually  make  a  faint  ef- 
fort at  peristalsis.  The  solar  plexus,  which  presides  over 
the  assimilative  functions  of  the  abdominal  organs  (not  in- 
appropriately called  the  abdominal  brain}  receives  a 
powerful  impetus  which  reverberates  throughout  the  sym- 
pathetic nervous  system  and  stimulates  metabolism  in  all 
parts  of  the  organism.  Gradually  the  contractile  and  di- 
gestive efforts  which  the  stomach  makes  become  more 
energetic.  The  pressure  symptoms  are  temporarily  relieved 
by  the  first  treatment.  In  rare  cases  this  does  not  occur. 
The  prognosis  then  is  accordingly  less  favorable.  .  The 
technique  of  stomach  massage  is  as  follows : 

The  patient  lies  on  his  back  with  his  knees  elevated,  and 
breathing  through  his  mouth.  The  operator  stands  on  the 
left  side  of  the  patient,  placing  his  right  or  left  hand  upon 
the  patient's  epigastrium.  Deep  but  gentle  pressure  with  the 
ball  portion  of  the  hand  alternates  with  pressure  by  the 
inner  surfaces,  not  the  tips,  of  four  fingers ;  at  the  same 
time  the  whole  hand  of  the  operator  is  rocked  to  a.nd  fro 
carrying  the  whole  epigastrium  with  it  without  sliding 
over  the  skin.  The  operator's  hand  must  at  all  times  re- 
main in  firm  contact  with  the  patient's  skin  and  carry  it 
along.  The  treatment  should  never  be  given  after  a  meal 
and  should  never  cause  pain.  Centra-indications  are  acute 
gastritis,  ulcer  and  cancer. 

VIBRATION. — The  vibrator  is  a  valuable  therapeutic 
agent  in  the  hands  of  a  well-informed  operator.  Deep  vibra- 
tion over  the  epigastrium  to  stimulate  the  nerve  supply  of 


394  MODERN  PHYSIO-THERAPY. 

the  stomach  should  be  given.  Gentle,  rapid  vibration  along 
the  course  of  the  phrenic  (side  of  neck  to  epigastrium) 
is  very  effective  in  helping  the  stomach  to  expel  the  gas. 
Deep  vibration  along  the  fourth  to  the  eighth  dorsal  ver- 
tebrae frequently  has  an  excellent  effect. 

ELECTRICITY. — A  weak  faradic  current  (rapid  interrup- 
tions) should  be  allowed  to  pass  through  the  stomach  with 
one  pole  in  the  pit  of  the  stomach,  the  other  pole  on  the 
bac!:.  Polarity  is  indifferent.  Sometimes  the  operator 
grasps  one  sponge-electrode  with  the  unengaged  hand  and 
allows  the  current  to  pass  while  massage  is  being  given, 
the  patient's  hand  holding  the  other  electrode.  Faradiza- 
tion of  the  vagus  is  excellent.  A  galvanic  application  is 
often  useful  (negative  pole  in  the  pit  of  the  stomach,  pos- 
itive pole  on  the  back).  An  indirect  negative  static  breeze 
is  beneficial,  if  applied  to  the  stomach  in  atonic  cases.  Some 
cases  do  well  under  a  high-frequency  current,  applied  to  the 
epigastrium  by  means  of  a  suitable  glass  electrode.  No 
electro-therapeutic  application  should  last  longer  than  ten 
minutes  nor  be  given  oftener  than  once  every  other  day. 

DIET. — Exclude  fat  and  well-done  meat.  Direct  the 
patient  to  eat  slowly,  chew  thoroughly  and  take  little  food 
at  a  time.  Find  the  kind  of  raw  fruit  that  the  patient's 
stomach  will  stand.  Milk,  as  a  rule,  should  be  avoided, 
like  all  articles  of  food  that  are  liable  to  ferment.  Put  the 
patient  on  a  largely  vegetable  diet,  avoid  sugar,  starches 
and  fats.  Meals  should  be  small.  Patient  should  be  given 
a  chance  to  appease  his  hunger,  but  not  to  crowd  his  stom- 
ach. It  is  important  to  individualize  each  case  in  connec- 
tion with  the  selection  of  the  proper  vegetables.  Fresh 
water  is  always  indicated,  buttermilk  iometimes,  beer  rarely. 
Light  wine  in  water  is  permissible.  Ice-cream  and  all  cold 
articles  should  be  positively  forbidden.  When  improve- 
ment becomes  manifest,  patient  can  be  tried  on  raw  eggs 
or  rare  lean  meat.  Remember  that  you  can  not  do  much 
harm  by  under-feeding,  but  you  can  kill  your  patient  by 
over- feeding  a  dilated  stomach.  Liquids  in  large  quanti- 


THERAPEUTIC  INDEX.  395 

ties  are  injurious  because  they  dilute  the  gastric  juice  too 
much  and  have  a  tendency  to  drag  the  stomach  out  of  its 
position  by  their  bulk  and  weight.  An  hour's  nap  after  a 
meal  is  to  be  recommended. 

Colon-irrigation  should  be  given  twice  or  three  times 
a  week,  with  the  patient  in  the  knee-chest  position. 

GENERAL  TREATMENT. — In  many  cases  of  chronic  dys- 
pepsia the  skin  is  sallow,  dry  and  ill  nourished.  Put  such  a 
patient  into  the  superheated  air-cylinder  at  least  once  a 
week  to  stimulate  skin  function  and  metabolism.  Tone  up 
the  patient's  general  system  by  a  general  high-frequency 
treatment  in  the  body  diasolenic  twice  a  week. 

The  wearing  of  an  abdominal  bandage  is  often  an  excel- 
lent means  of  counteracting  the  tendency  of  the  stomach 
to  gravitate  out  of  its  normal  position  (gastroptosis).  A 
patient  should  be  encouraged  to  get  as  much  light  and  air 
as  possible.  In  all  disorders  of  nutrition  and  metabolism, 
fresh  air  is  a  therapeutic  agent  of  wonderful  efficacy  be- 
cause it  adds  oxygen  to  the  physiological  combustion  which 
is  going  on  in  the  economy.  Light  stimulates  the  skin- 
c-xcretion  and  is,  therefore,  an  important  factor. 

The  laboratory  methods  of  studying  the  diseases  of  the 
stomach  (chemical  examination  of  gastric  fluids,  test- 
meals,  etc.)  have  yielded  comparatively  little  in  a  practical 
way.  If  the  human  stomach  were  a  chemical  test-tube,  we 
could,  by  demonstration  and  deduction,  glean  much  infor- 
mation of  positive  practical  value  in  reference  to  the  dis- 
orders of  the  stomach.  There  is  an  element  of  life  in  every 
organic  being  which  makes  the  laboratory  work  of  the  phys- 
iological chemist,  however  interesting  and  praiseworthy  his 
efforts  may  be,  a  vague  uncertainty.  This  element  of  in- 
dividual life  is  what  Pettenkofer  has  called  the  "physiolog- 
ical subjectivity  of  the  individual.''  It  is  the  physiological 
personal  equation  of  the  patient's  organism.  It  is  the  un- 
defined, intangible  element  of  individual  life.  A  dozen 
cases  of  dilatation  of  the  stomach  may  yield  a  dozen  differ- 
ent chemical  results  to  the  analyzing  physiological  chem- 


3%  MODERN  PHYSIO-THERAPY. 

ist.  Every  one  of  these  cases  improves  under  the  treat- 
ment outlined  above.  Chemical  tests  indicate  the  return  to 
the  normal  condition.  All  this  goes  to  show  that  correc- 
tion of  structural  changes  is  followed  by  a  restoration  of 
function.  Why  one  dilated  stomach  should  yield  chemical 
results  indicating  an  increase,  a  decrease  or  an  absence  of 
a  certain  chemical  constituent  of  the  gastric  fluid  while 
another  case  shows  a  disproportion  of  an  entirely  differ- 
ent character,  and  why  both  cases  upon  proper  treatment, 
especially  massage  and  diet,  improve  even  to  the  extent  of 
producing  normal  secretions,  is  one  of  the  biological  mys- 
teries that  will  never  be  solved  until  the  veil  is  lifted  from 
life  itself.  Experience  has  shown  that  physiological  chem- 
istry has  added  comparatively  little  to  the  rational  therapy 
of  diseases  of  the  digestive  organs. 

In  handling  chronic  dyspepsia,  it  is  essential  to  individ- 
ualize each  case.  The  one  all-important  fact  to  be  remem- 
bered is  that  even  in  an  advanced  case  of  gastric  atony 
dilatation,  dyspepsia),  the  symptoms  do  not  necessarily  point 
to  the  stomach.  The  appetite  may  be  good  and  even  rav- 
enous. The  bowels  may  be  regular.  The  symptoms  may 
all  be  of  the  nervous  type :  insomnia,  excitability,  neuralgia, 
defective  memory,  headache,  dizziness,  nervousness,  drowsi- 
ness after  a  meal,  feeling  bad  after  a  nap,  worry,  hypochon- 
driacal  manifestations,  hysteria  and  even  insanity.  There 
may  be  backache,  paralysis,  heart  symptoms,  rheumatism 
and  one  or  the  other  of  the  almost  innumerable  forms  of 
auto-intoxication.  (See  FUNCTIONAL  DISORDERS  and 
REFLEX  DISORDERS.)  In  all  non-parasitic  and  non-luetic 
skin-diseases  always  look  to  the  stomach.  Add  whatever 
special  features  of  treatment,  locally  and  generally,  may 
be  required  in  the  individual  case.  If  malnutrition  has 
given  rise  to  neuralgia,  muscular  pains  or  skin-troubles, 
do  not  neglect  these  outward  manifestations  or  results  while 
trying  to  remove  the  cause.  Relieve  symptoms  by  suitable 
means  (massage  or  electricity  in  pains  of  nerves  and  mus- 
cles, high-frequency  currents  in  skin  diseases,  not  to  speak 


THERAPEUTIC  INDEX.  397 

of  the  vast  therapeutic  possibilities  offered  by  hydro-  and 
thermo-therapy . )  In  a  general  way  it  may  be  said  that  in 
the  treatment  of  all  chronic  diseases  the  physician  will  never 
make  a  mistake  if  he  includes  the  stomach  in  his  clinical 
reasoning.  When  I  was  a  student  of  medicine,  I  had  a 
professor  who  was  in  the  habit  of  repeating  the  following 
admonition  so  frequently  that  it  became  a  byword  among, 
the  students.  He  was  wont  to  say:  "If  you  don't  know, 
what  is  the  matter  with  your  patient,  look  wise  and  give 
him  iodide."  From  a  therapeutic  standpoint  a  worse  state- 
ment could  not  be  made.  The  physio-therapeutist  who  has 
gathered  experience  in  the  treatment  of  chronic  diseases, 
is  in  a  position  to  revise  the  above  statement  for  the  benefit 
of  the  many  unfortunate  chronics  who  have  run  the  gaunt- 
let of  drug-medication  and  of  doctors.  The  admonition 
should  read:  "If  you  don't  know  what  is  the  matter  with 
your  patient,  act  wisely  by  treating  him  for  atony  of  the 
stomach."  The  results  in  not  a  few  stubborn  and  obscure 
cases  justify  the  diagnosis  and  compensate  for  the  effort. 

Electro-cautery. — For  the  purpose  of  heating  up  a 
cautery-electrode  the  lighting  circuit  (direct  or  alternating), 
the  storage  battery  or  primary  cells  are  available.  The  re- 
sistance of  a  cautery  is  rarely  more  than  1-10  ohm  with  a 
voltage  of  from  2  to  6  and  variable  amperage  of  from 
I  to  50,  depending  on  the -construction  of  the  electrode.  A 
cautery-battery  can  not  be  used  to  furnish  incandescent  light. 
A  light  current  requires  higher  voltage  to  overcome  high 
resistance  while  the  current  strength  is  comparatively  low. 

Emphysema. — The  rational  therapy  of  this  typical 
chronic  disease  is  suggested  by  its  pathology.  Locally  there 
is  an  enormous  passive  hyperemia,  systemically  we  find  all 
the  evidences  of  ill  nutrition  and  functional  torpidity.  The 
skin  is  dry  and  sallow,  stomach  and  bowels  usually  inactive, 
symptoms  of  auto-intoxication  are  common.  (See  FUNC- 
TIONAL DISORDERS.)  The  disturbance  in  the  pulmonic  cir- 
culation eventually  affects  the  heart  and  the  general  cir- 
culation. The  general  regime  outlined  under  the  head  of 


398  MODERN  PHYSIO-THERAPY. 

VALVULAR  DISEASES  OF  THE  HEART  is  entirely  proper  in 
the  treatment  of  emphysema.  Above  all  things  stimulation 
of  the  cutaneous  circulation  is  of  paramount  importance 
in  order  to  counteract  stagnation  in  the  lungs  and  subse- 
quent effects  on  the  circulation  at  large.  This  should  be  the 
object  of  mechano-,  thermo-,  hydro-  and  photo-therapeutic 
procedures.  The  surroundings  and  habits  of  the  patient 
should  be  hygienically  perfect.  Mountain-climbing"  and  in- 
halation of  compressed  air,  as  suggested  by  Oertel,  are  a 
fine  therapeutic  combination.  Chest-exercises,  as  outlined 
under  the  head  of  TUBERCULOSIS  PULMONUM,  are  valuable. 

Vibration  can  be  used  to  augment  massage  of  the  ex- 
tremities. It  can  be  given  over  the  chest  and  over  the 
cervical  vertebrae.  Galvanism  (positive  over  chest,  neg- 
ative on  nape  of  neck ;  or  to  side  of  neck  below  ear  and  to 
epigastrium)  is  useful.  Let  patient  sit  in  a  warm  bath  (pos- 
itive on  nape  of  neck,  negative  in  water)  for  ten  minutes 
every  other  day.  Static  insulation  (negative),  also  static 
spray  (positive)  over  chest,  are  serviceable.  The  general 
high-frequency  application  (cage  or  diasolenic)  is  valu- 
able. Applied  to  the  spine  by  means  of  a  vacuum-electrode, 
the  high-frequency  current  is  a  fine  respiratory  and  cir- 
culatory stimulant. 

Endometritis. — The  management  of  an  acute  inflam- 
mation of  the  lining  membrane  of  the  uterus  should  be  con- 
ducted according  to  the  principles  laid  down  under  the  head 
of  INFLAMMATION  (ACUTE).  Attention  to  the  functions  of 
the  bladder  and  bowels  is  important,  if  necessary  with  the 
aid  of  the  catheter  and  the  fountain  syringe.  Warm  vag- 
inal douches  twice  daily,  warm  sitz-bath  or  local  electric- 
light  bath  daily  and  hot  application  to  the  lower  extrem- 
ities (vapor,  moist  packs).  A  Priessnitz  rompress  on  the 
abdomen  has  a  fine  depletent  effect. 

The  chronic  variety  of  the  disease  is  one  of  the  most 
common  diseases  of  women.  For  general  directions  see 
INFLAMMATION  (CHRONIC).  The  most  important  rule  for 
the  local  treatment  is  the  enforcement  of  cleanliness  and 
the  stimulation  of  the  local  circulation  by  means  of  hot 


THERAPEUTIC  INDEX.  399 

vaginal  douches.  The  galvanic  current  renders  excellent 
service  in  these  cases.  Negative  electrolysis  is  indicated 
in  most  cases  (negative  uterine  electrode,  positive  abdom- 
inal electrode,  twenty  to  forty  milliamperes,  fifteen  to  twenty 
minutes  every  three  days).  In  hemorrhagic  cases  positive 
electrolysis  with  copper  electrode  in  uterus,  negative  elec- 
trode on  abdomen,  dosage,  etc.  as  before.  Elect  ode  musr 
be  released  by  reversing  current  before  withdrawing.  (See 
ELECTROLYSIS — Part  I  of  book.)  In  reversing  the  current, 
always  turn  it  off  first  and  then  reverse,  in  order  not  to 
shock  the  patient.  After  the  treatment  a  vaginal  vacuum- 
electrode  can  be  used  to  administer  a  high-frequency  cur- 
rent for  the  purpose  of  producing  a  local  alterant  effect. 
Massage  of  the  local  extremities  to  help  in  the  deple- 
tion of  the  pelvic  congestion  is  useful.  Certain  Swedish 
movements  augment  the  effect  (bending  the  feet,  knees,  hips 
with  the  patient  resisting;  lying  down  and  slowly  raising 
the  body  from  the  hips  up  to  the  sitting  posture).  These 
movements  increase  the  circulation  in  the  lower  extremities 
and  abdominal  wall.  Cold  douches  to  the  femoral  region 
with  the  patient  standing  have  a  powerful  depleting  effect. 
'  Vibration,  both  central  and  peripheral,  is  a  valuable 
agent.  Centrally  it  should  be  applied  to  the  two  lower  dor- 
sal and  three  upper  lumbar  vertebrae  with  light  and  rapid 
strokes  for  three  to  five  minutes  every  other  day.  Periph- 
erally the  applicatio  n  can  be  made  with  a  flat  vibrating 
attachment  over  the  pubic  region.  The  knees  of  the  pa- 
tient should  be  drawn  up,  patient  breathing  through  the 
mouth.  This  form  of  peripheral  vibration  is  out  of  the 
question  in  very  fat  subjects.  Intra vaginal  vibration  rec- 
ommended by  some,  is  of  doubtful  value  in  these  cases. 
Static  electricity  is  frequently  indicated.  The  best  ap- 
plication is  probably  the  positive  spray  to  the  pelvis.  In 
many  cases,  especially  if  pain  and  hemorrhage  are  promi- 
nent symptoms,  suspension  of  sexual  relations  is  impera- 
tive. Additional  therapeutic  directions  are  found  under 
INTRA-PELVIC  INFLAMMATIONS. 


400  MODERN  PHYSIO-THERAPY. 

Enlarged  Tonsils. — Positive  electrolysis  with  platinum- 
needle,  short  applications,  negative  pole  in  hand,  five  to 
fifteen  milliamperes  for  five  to  ten  minutes  every  day  or  two. 
Negative  electrolysis  with  fiat  metal-electrode  to  surface 
of  tonsil  or  by  steel-needle  in-  the  tonsil,  positive  pole  in 
hand,  continued  until  dehydration  shows,  to  be  repeated 
every  day  or  two.  Galvano-cautery  is  useful. 

Enteritis. — Acute  inflammation  of  any  part  of  the  in- 
testinal canal  should  be  managed  according  to  the  general 
directions  given  under  the  head  of  INFLAMMATION 
(ACUTE),  PERITONITIS,  GASTRITIS,  FEVER. 

The  treatment  of  chronic  enteritis  (intestinal  catarrh)  is 
largely  a  hygienic  and  dietetic  problem.  (See  DYSPEPSIA, 
INFLAMMATION  (CHRONIC),  COLON-IRRIGATION  and  the 
chapter  on  PERSONAL  HYGIENE  and  DIETETICS.)  Hot  ap- 
plications should  be  made  to  the  abdomen.  Bowel-symp- 
tcms  should  be  treated  in  keeping  with  the  indications. 
(See  DIARRHEA  and  APPENDICITIS.) 

Epilepsy. — Lesions  of  the  nervous  system  (traumatic, 
syphilitic)  are  but  rarely  the  causes  of  epilepsy.  The  dis- 
ease represents  an  impairment  of  functional  equilibrium 
which  might  be  due  to  any  cause  capable  of  disturbing 
nerve-function.  (See  FUNCTIONAL  DISORDERS,  NEURAS- 
THENIA, HYSTERIA,  DYSPEPSIA.)  The  therapy  of  the  dis- 
ease includes  the  suggestive  influences  of  a  good  and  well- 
regulated  home-life  and  the  educational  advantages  of  as- 
sociation. Perfect  hygiene  in  the  surroundings,  the  daily 
life  and  in  the  dietetic  and  sexual  habits  of  the  patient  should 
be  enforced.  Look  for  exciting  causes  (tight  prepuce, 
menstrual  disorders,  alcoholism,  sexual  aberrations,  con- 
stipation, etc.).  Eliminative  treatment  supplemented  by 
measures  to  tone  up  the  system  should  be  instituted.  Gal- 
vanism once  daily  is  useful  (positive  head,  negative  back 
of  neck;  also  positive  to  back  of  neck,  negative  in  warm 
bath).  Positive  static  spray  to  spine  or  head,  also  positive 
static  insulation  are  valuable.  Vibration  over  dorsal  ver- 
tebrae can  be  given  every  day.  Patient  should  be  kept  free 


THERAPEUTIC  INDEX.  401 

from  excitement.  Tobacco,  alcohol  and  meat  should  be 
avoided.  (See  chapters  on  DIETETICS  and  PERSONAL  HY- 
GIENE.) In  epilepsy,  as  in  all  so-called  functional  diseases 
of  the  nervous  system,  suggestive  therapy  systematically 
employed  is  of  the  greatest  value. 

Fatty  Degeneration  of  the  Heart. — The  therapeutic 
directions  given  under  the  head  of  VALVULAR  DISEASES  OF 
THE  HEART  (systemic  dehydration)  are  applicable.  Sun- 
baths,  the  thermic  cylinder,  the  general  electric-light  bath 
are  serviceable.  In  conjunction  with  these  dehydrating  meas- 
ures, the  patient  should  be  given  a  tissue-building  (nitrog- 
enous) diet:  beans,  peas,  lentils,  spinach,  roast-beef,  beef- 
steak, lean  mutton,  game,  eggs,  with  moderate  quantities  of 
carbo-hydrates.  Liquids  should  be  given  sparingly.  The 
patient  might  be  given  one  cup  of  weak  coffee  (tea),  milk, 
one  small  plate  of  soup  and  one  glass  of  water  daily.  This 
is  an  average  allowance.  Patients  soon  become  accustomed 
to  these  small  quantities  of  liquid  food.  The  sensation  of 
thirst  can  often  be  quieted  by  gargling  with  fresh  water. 
The  general  dietetic  regime  should  be  closely  adapted  to 
the  individual  patient's  condition.  Rest  in  the  recumbent 
po'sition  several  hours  a  day  is  very  beneficial.  Massage, 
Swedish  movements,  etc.,  should  be  practiced,  as  suggested 
under  the  head  of  VALVULAR  DISEASES  OF  THE  HEART. 

Fever. — The  true  nature  of  fever  as  a  restorative  agent 
has  been  repeatedly  indicated  in  this  book.  (See  THE  PHIL- 
OSOPHY OF  PHYSIOLOGICAL  THERAPEUTICS  and  THE  THER- 
APEUTIC EFFECTS  OF  HEAT  AND  COLD.)  Fever  is  accel- 
erated and  intensified  oxidation.  Its  systemic  effects  are 
those  of  more  active  and  more  rapid  tissue  change.  Its  out- 
ward manifestation  is  elevated  temperature.  The  latter  is 
of  no  concern  unless  it  exceeds  certain  limits  and  endangers 
the  integrity  of  the  tissues  and  the  organism  at  large  by 
coagulation  of  somatic  albumen  and  by  the  consequent  dis- 
integration of  vital  nerve-centers.  Hyperryrexia  of  this 
kind  is  sometimes  found  in  cases  of  sunstroke,  rheumatism, 
etc.,  and  is  usually  fatal.  Under  ordinary  circumstances  the 


402  MODKRN  PHYSIO-THERAPY. 

elevation  of  the  temperature  is  physiologically  and  clin- 
ically secondary  to  the  increased  oxidation  which  consumes 
the  tissues  of  the  body  and  aims  at  restoration  of  normal 
conditions  by  regenerating  the  body  and,  in  doing  so,  get- 
ting rid  of  disease-producing  and  disease-constituting  ma- 
terial. To  lower  the  temperature  means  nothing  unless  it 
be  preceded  by  and  associated  with  removal  of  the  cause 
which  gives  rise  to  the  pyrexia.  (See  TYPHOID  FEVER.) 
This  indicates  the  sophistry  of  what  is  done  clinically  in 
the  way  of  antipyretic  treatment,  especially  by  means  of  the 
so-called  coal-tar  derivatives.  The  modus  operandi  of  the 
latter  is  plain.  The  red  corpuscles  of  the  blood  which  are 
the  true  carriers  of  the  heat-producer  (oxygen)  are  disin- 
tegrated in  large  numbers  by  the  coal-tar  products.  Oxida- 
tion lags  as  ?.  result,  and  the  temperature,  the  external  evi- 
dence of  the  oxidation,  drops.  The  heat-units  are  excreted 
through  compensating  action  of  the  skin.  Hence,  there  is 
diaphoresis  and  usually  considerable  weakness.  Cyanosis 
is  due  to  temporary  retention  of  CO2  and  lessening  of 
oxygen.  Physiologically  this  kind  of  antipyresis  adds  an 
additional  element  of  danger  to  the  already  existing  diffi- 
culty. The  physician  should  never  address  his  efforts  to 
the  elevated  temperature  but  to  the  underlying  causative 
factor.  Therein  lies  the  philosophy  of  the  hydro-therapeutic 
fever-treatment. 

There  are  certain  features  of  fever-treatment  that  apply 
in  all  morbid  conditions  characterized  by  elevation  of  tem- 
perature. The  first  rule  of  action  is :  Open  the  emunctories. 
The  bowels  should  be  moved,  the  kidneys  stimulated  and, 
above  all,  the  skin  should  be  made  to  perform  the  lion's 
share  of  excretion.  This  holds  good  in  all  feverish  con- 
ditions. 

In  the  acute  exanthemata  especially  during  the  stage  of 
active  eruption  cold  applications  are  contra-indicated.  The 
skin  should  be  stimulated  by  heat,  preferably  by  a  steam- 
bath  or  vapor-bath,  which  can  be  given  to  the  patient  while 
he  lies  in  bed.  The  technique  is  simple.  Two 


THERAPEUTIC  INDEX.  403 

hoops  are  cut  in  two,  and  the  four  pieces  placed  over  the 
patient  from  the  neck  to  the  feet.  A  sheet  of  some  water- 
proof material  is  placed  over  these  hoops,  which  thus  serve 
to  keep  the  sheet  from  resting  on  the  patient.  The  head  of 
the  patient  is  left  out.  The  sheet  should  reach  from  the 
neck  to  below  the  feet  and  be  closed  at  both  ends.  An 
alcohol-lamp  or  gas-burner  is  placed  on  either  one  or  both 
sides  or  at  the  foot  of  the  bed.  By  means  of  one  or  two 
good-sized  tubes  cf  some  sort  the  hot  air  or  vapor  is  di- 
rected into  the  space  between  the  sheet  and  the  patient.  In 


VAPOR-BATH  FOR  A  BED-RIDDEN  PATIENT. 

this  way  the  patient's  skin  can  be  made  to  excrete  freely. 
This  application  illustrates  the  antipyretic  effects  of  heat. 
The  diet  in  all  fevers  should  be  tissue-building  to  com- 
pensate for  the  loss  entailed  during  the  tissue-consuming 
fever-process.  (See  DIETETICS.)  For  obvious  reasons 
liquid  or  semi-liquid  food,  frequently  given  in  small  quan- 
tities, is  indicated  in  all  fever  cases.  (See  DIET  IN  ACUTE 

FEVERS.) 

To  counteract  enervation  from  long-continued  pyrexia, 
the  cold  sponge-bath  (Abreibung,  Abklatschung)  or  douche 
should  be  resorted  to.  The  nervous  system  is  wonderfully 
upheld  by  these  means. 

Fibroid  Tumors. — Negative  electrolysis.  (See  Part 
I  of  the  book.)  Negative  pole  near  tumor  (on  abdomen 


404  MODERN  PHYSIO-THERAPY. 

or  in  uterus)  ten  to  one  hundred  milliamperes  for  ten  to 
twenty  minutes  every  four  or  six  days.  Positive  pole  on 
back.  In  hemorrhagic  cases  reverse  position  of  the  poles 
given  above.  Use  copper  or  zinc  tip  with  positive  pole. 
Reverse  current  to  release  positive  electrode  before  attempt- 
ing to  remove  it.  Use  of  needle  is  dangerous  and  not  more 
effective  than  method  given.  Apostoli  uses  two  hundred 
and  more  milliamperes  in  his  negative  electrolytic  method. 
Good  symptomatic  cures  are  sometimes  effected  by  using 
ten  to  thirty  milliamperes  for  ten  to  fifteen  minutes  every 
other  day,  positive  pole  in  the  uterus  if  the  tumor  is  sub- 
mucous  or  intra-mural.  In  the  sub-peritoneal  cases  Apos- 
toli's  method  (powerful  negative  electrolysis)  is  more 
effective. 

Fistula  in  Ano. — Introduce  a  metal  probe  throughout 
the  full  length  of  the  canal  and  connect  with  positive  pole 
of  a  galvanic  current.  Technique  as  given  under  ANAL 
FISSURE.  Treatment  ought  to  be  repeated  every  week. 
Sometimes  negative  electrolysis  (negative  pole  to  probe) 
seems  to  answer  better.  For  general  directions  see  HEM- 
ORRHOIDS. 

Flexions  of  the  Womb. — In  cases  of  forward  bending 
(anteflexion)  of  the  uterus,  the  cause  should  be  taken  into 
account  and  treated  (metritic,  peri-  and  para-metritic  con- 
ditions, fibroids,  etc.).  The  uterus  should  be  massaged 
loose  from  adhering  neighboring  structures.  Acute  inflam- 
matory symptoms  are  a  contra-indication  to  massage. 
Faradization  is  useful  (mild  current  for  15  minutes  every 
other  day,  one  pole  beyond  the  cervical  canal,  the  ctlier  pole 
high  up  in  the  rectum  resting  on  the  body  of  the  flexed 
uterus).  If  the  uterus  is  ill-nourished,  galvanization  can 
be  substituted.  Pessaries  are  worse  than  useless.  In  cases 
of  backward-bending  (retroflexion)  of  the  womb  the  pros- 
pects of  a  cure  are  not  very  bright.  Massage  might  be 
employed  to  break  up  adhesions  and  help  the  uterus  to  main- 
tain its  natural  position.  Faradization  (one  pole  to  the 
uterus,  the  other  in  the  bladder)  has  been  recommended  by 


THERAPEUTIC  INDEX.  405 

Tripier.  The  treatment  of  anteversions  and  retroversions 
does  not  differ  in  principle  from  that  adopted  in  flexions 
of  the  uterus. 

Freckles  (Lentigo). — Negative  electrolysis  with  very 
fine  steel  needle.-  Positive  pole  in  hand. 

Functional  Disorders. — That  increase,  decrease  or  per- 
version of  function  can  not  exist  per  se,  but  is  necessarily 
associated  with  and  dependent  upon  structural  or  nutritional 
changes  in  the  cellular  elements  whose  functional  activity 
appears  accentuated,  diminished  or  altered,  is  a  generally 
admitted  physiological  principle.  It  is  clear,  therefore,  that 
there  can  be  no  functional  disorder  per  se.  The  functional 
activity  of  cell-elements  of  an  organ  or  structure  depends 
upcn  their  nutrition.  If  the  latter  is  increased  (hyperemia). 
stimulation  of  function  must  necessarily  follow.  If  nutrition 
is  so  active  that  the  cell-elements  can  not  appropriate  or 
assimilate  it,  the  result  is  a  violent  reaction  characterized 
by  all  the  evidences  of  over-nutrition  and  coexisting  stasis. 
This  condition  involves  exhaustion  of  the  functional  power 
and  is  known  as  active  congestion  or  inflammation.  If  the 
cfell-elements  of  an  organ  receive  less  than  their  physiolog- 
ical share  of  nutriment  (anemia),  functional  power  will  nec- 
essarily and  proportionately  be  depressed.  If  they  receive  the 
wrong  kind  of  nutriment  (ischemia),  deviations  from  the 
normal  functional  standard  might  be  the  result.  If  the 
blood  carries  morbid  elements  of  any  kind,  e.  g.  derivatives 
of  germ  life  or  of  normal  secretions  or  excretions  of  the 
organism,  toxines  and  various  products  of  a  retrograde  met- 
amorphosis, the  cell-elements  might  give  rise  to  erratic 
functional  manifestations.  (See  AUTO-INTOXICATION.)  If 
the  affected  cell-elements  happen  to  belong  to  some  nerve 
or  nerve-plexus  it  is  plain  to  see  that  an  infinite  number 
and  variety  of  manifestations  might  result  therefrom.  The 
closely  and  intricately  interwoven  network  of  the  nervous 
system  may  receive  an  impulse  or  suffer  an  irritation  at  any 
one  point ;  the  result  might  be  some  motor  or  sensory  dis- 
turbance in  the  area  controlled  by  that  particular  nerve  or 


406  MODERN  PHYSIO-THERAPY. 

nerve-plexus.  The  impulse  or  irrituii  ;i  might  be  transmit- 
ted by  continuity  of  structure  through  interlacing  sympa- 
thetic nerves  and  might  cause  symptoms  or  manifestations  in 
a  remote  place  and  of  an  entirely  different  character  from 
that  of  the  original  stimulus,  impetus  or  irritation.  Therein 
lies  the  pathology  of  the  so-called  reflex  disorders.  The 
transmission  of  impulses  of  this  kind  follows  the  direction 
of  least  resistance.  Why  a  certain  path  offers  less  re- 
sistance than  any  other  and  why,  therefore,  manifestations 
of  a  certain  kind  follow,  is  not  easy  to  determine.  Therein 
lies  the  difficulty  of  accounting  for  these  reflex  disorders. 
There  is  no  doubt,  however,  that  undue  irritability  of  a 
nerve-fiber  indicates  a  loss  of  resisting  power  or  tone  and  is 
also  an  evidence  of  increase,  decrease  or  perversion  of  nu- 
trition. 

Both  functional  and  reflex  disorders  are  only  secondarily 
connected  with  the  activity  of  the  nerve-mechanism.  Pri- 
marily they  must  be  aberrations  of  nerve-nutrition  for  rea- 
sons cited  above.  It  is  clear,  therefore,  that  the  study  of 
nutrition  and,  therefore,  of  the  blood,  is  of  paramount  clin- 
ical importance.  The  physician  should  remember  at  all 
times  that  the  blood  is  the  medium  of  metabolism.  It  is  the 
carrier  of  food,  of  fuel,  of  heat  and  of  waste  according  to 
certain  physiological  laws.  It  receives  food  through  the 
lungs  and  through  the  stomach.  It  assumes  different  forms 
of  consistency,  composition  and  character  in  keeping  with 
the  activity  of  the  different  organs.  It  carries  the  food  ele- 
ments to  the  lungs  and  exposes  them  to  oxidation.  It  de- 
posits waste  in  the  organs  of  excretion.  Thus  we  see  that 
the  blood  is  the  factor  upon  which  metabolism  hinges.  If 
metabolism  in  any  of  its  phases  or  in  any  part  of  the  body 
is  disturbed,  the  blood  is  concerned  primarily.  Secretions 
may  fail  in  their  natural  function  and  undergo  chemical 
changes.  Excretions  and  combustion  products  may  be  re- 
tained and  again  enter  the  circulation.  All  these  substances 
are  foreign  to  the  physiological  purposes  of  metabolism, 
and,  therefore,  are  to  all  intents  and  purposes  poisons.  Their 


THERAPEUTIC  INDEX.  407 

presence  in  the  body  is  equivalent  to  an  ischemia,  and  may 
give  rise  to  an  endless  and  numberless  variety  of  symptoms 
of  poisoning  through  malnutrition  (perverted  nutrition)  of 
the  organism,  wholly  or  in  part.  This  is  what  is  meant  by 
auto-intoxication,  the  most  powerful,  the  most  variable 
and  the  most  neglected  etiological  factor  in  the  production 
of  disease  and  its  symptoms.  It  is  the  pathology  of  most 
so-called  functional  and  reflex  disorders.  It  is  the  one  fac- 
tor which  explains  the  clinical  features  of  many  chronic 
diseases. 

In  the  non-parasitic  skin-diseases  auto-intoxication  of 
some  sort  or  other  is  the  dominating  etiological  factor. 
Toxic  conditions  of  the  skin-nerves  may  cause  changes  in 
the  trophic  condition  of  the  skin.  The  disease  may  be  co- 
incident with  an  intense  eliminative  effort  made  by  the 
skin  (e.  g.  in  syphilis).  In  all  non-parasitic  skin-diseases 
the  condition  of  the  skin  is  secondary  to  the  toxic  state 
which  prevails  within  the  system  and  finds  its  outward 
expression  in  the  cuticle.  To  go  into  detail  and  describe  the 
pathological  changes  in  the  skin  is  of  no  diagnostic  value 
because  all  these  changes  are  secondary  to  the  actual  causa- 
tive factor  which  precedes  the  disease  of  the  skin,  to  wit: 
a  disturbance  of  local  or  general  metabolism.  This  explains 
the  futility  of  local  treatment  in  these  cases  and  liability  to 
recurrence. 

In  view  of  all  these  facts  we  are  prepared  to  understand 
the  philosophy  of  the  Hippocratic  dictum  concerning  the 
four  emunctories.  (See  chapter  on  PERSON AI,  HYGIENE.) 
The  prophylaxis  of  disease  lies  largely  in  physiological  ex- 
cretion. The  cure  of  disease,  especially  chronic  disease, 
depends  on  our  relative  ability  to  promote,  control  and  reg- 
ulate excretion.  This  is  what  gives  hydro-  and  thermo- 
therapy  their  commanding  place  in  clinical  medicine.  In  all 
chronic  diseases  auto-intoxication  is  the  one  factor  that 
must  be  reckoned  with  and  must  be  conquered.  With 
these  facts  in  our  mind  we  are  able  to  understand  the  nature 
of  rheumatism,  the  symptomatology  of  many  diseases  of 


408  MODERN  PHYSIO-THERAPY. 

women,  and,  above  all,  we  are  prepared  to  attempt  the  treat- 
ment of  diseases  of  the  nervous  system  that  are  so  univer- 
sally misinterpreted  and  unsuccessfully  handled.  We  are 
ready  to  admit  that  functional  and  reflex  disorders  have  no 
pathological  significance  because  they  are  invariably  sec- 
ondary to  and  symptomatic  of  some  underlying  disorder  of 
nutrition. 

General  and  local  elimination  is  the  keynote  of  treat- 
ment in  all  functional  disorders.  Irrigation  of  the  colon 
is  indispensable.  In  most  persons  the  colon  is  a  stagnant 
sewer  full  of  filth  and  infection.  Metschnikoff  believes  that 
man  would  live  to  an  average  age  of  one  hundred  and  fifty 
to  two  hundred  years  if  it  were  not  for  the  fact  that  he 
carries  the  germs  of  decay  and  death  constantly  in  his 
large  intestines.  The  importance  of  colon-irrigation  can 
not  be  overrated  in  cases  of  functional  disorders  due  to  ill- 
defined  causes.  Its  effect  should  be  supplemented  by  gen- 
eral elimination  through  the  skin  (electric-light  bath, 
thermic  cylinder).  General  massage  can  be  added.  The 
diet  should  be  non-nitrogenous  in  all  these  cases.  The 
patient  should  be  taught  the  hygienic  value  of  water-drink- 
ing. The  local  treatment  depends  entirely  on  the  indica- 
tions presented  by  the  individual  case.  Above  all  things 
try  to  find  the  source  of  all  the  trouble.  Try  to  understand 
the  philosophy  of  auto-intoxication  as  a  causative  factor  of 
disease.  Study  the  function  of  the  several  organs  that 
might  be  concerned  in  the  production  of  a  toxaemic  state. 
In  the  order  of  their  relative  importance  as  disease-pro- 
ducers, they  are:  the  stomach,  the  colon,  the  uterus,  the 
liver,  the  kidneys.  Some  forms  of  auto-intoxication  are  fa- 
miliar, like  rheumatism  and  chronic  Bright's  disease.  The 
obscure  and  unidentified  varieties  that  are  caused  by  disor- 
ders of  the  stomach  and  colon  represent  the  bulk  of  chronic 
functional  diseases  without  a  well-defined  clinical  or  path- 
ological identity,  especially  the  many  conditions  classified 
under  the  head  of  HYSTERIA,  HYPOCHONDRIASIS,  NEURAS- 
THENIA, NERVOUSNESS,  PARALYSIS,  NEUROSES,  REFLEX  DIS- 
ORDERS, and  DISEASES  OP  THE  SKIN. 


THERAPEUTIC  INDEX.  409 

Gastric  Cancer. — In  the  first  stages  of  the  disease  the 
patient  should  be  restricted  to  a  copious  vegetable  diet  with 
as  little  liquid  food  as  is  compatible  with  the  patient's  com- 
fort. Koumiss  is  a  most  valuable  dietetic  article  for  these 
cases.  Irrigation  of  the  colon,  stimulation  of  the  skin  by 
dry  heat  or  hot  packs  and  sun-baths  are  to  be  prescribed. 
The  object  of  a  regime  of  this  kind  is  to  make  a  profound 
impression  on  metabolism  and  prevent  the  rapid  systemic 
degeneration  which  gastric  cancer  produces.  Life  is  pro- 
longed in  this  way  (Schroth).  In  the  latter  stages  of  the 
disease  treatment  is  purely  symptomatic.  The  X-rays  have 
an  anodyne  effect  in  some  cases.  The  relation  of  meat  to 
cancer  is  referred  to  under  the  head  of  INOPERABLE  MA- 
LIGNANT DISEASE. 

Gastric  Ulcer. — The  vast  majority  of  cases  of  ulcer  of 
the  stomach  occur  in  anemic  and  chlorotic  subjects.  That 
anemia  and  chlorosis  are  predisposing  factors,  if  not  causa- 
tive conditions  of  gastric  ulcer,  seems  certain.  The  gen- 
eral condition  of  the  patient  should  receive  the  first  atten- 
tion of  the  physician.  (See  ANEMIA.)  The  diet  of  the 
patient  must  be  restricted  to  milk,  rice  and  food-drinks 
mentioned  under  the  head  of  GASTRITIS.  Fruit- juices,  cocoa, 
light  wine,  are  permissible.  Sometimes  rectal  alimentation 
must  be  resorted  to.  Locally  all  violent  forms  of  therapy 
(massage,  vibration,  etc.)  are  contra-indicated.  The  gen- 
eral regime  is  more  important  than  the  local  treatment. 

Gastritis. — Acute  inflammation  of  the  stomach  requires 
i  est  generally  and  locally.  Irrigation  of  the  stomach  per  os 
and  of  the  colon  per  rectum  is  indicated  at  the  beginning 
of  the  attack.  The  diet  should  consist  of  small  quantities 
of  liquid  or  semi-liquid  food.  Water  in  which  oats,  barley, 
rice  has  been  boiled  is  a  splendid  article  of  food.  The  white 
of  egg  beaten  up  in  water  is  very  serviceable.  These  food- 
drinks  should  be  seasoned  and  served  to  suit  the  individual 
patient.  Feeding  per  rectum  is  sometimes  necessary.  Hot 
drinks  have  a  sedative  effect  on  the  stomach  and  are  indi- 
cated to  control  vomiting.  The  general  features  of  the 


410  MODERN  PHYSIO-THERAPY. 

proper  regime  are  suggested  under  the  head  of  INFLAM- 
MATION (AcuTE)  and  FEVER.  If  gastritis  is  caused  by  a 
corrosive  or  otherwise  irritating  poison,  the  treatment  should 
be  begun  with  proper  measures  to  neutralize  the  irritating 
effect  of  the  poison.  Massage  is  contra-indicated  in  acute 
inflammation  of  the  stomach. 

Chronic  gastritis  (catarrh  of  the  stomach)  should  be 
handled  according  to  the  principles  laid  down  under  the 
head  of  INFLAMMATION  (CHRONIC)  and  DYSPEPSIA.  Lav- 
age  of  the  stomach  is  indicated  in  cases  of  catarrh  of  the 
stomach  characterized  by  large  quantities  of  mucus.  Drink- 
ing one  or  two  pints  of  water  before  meals  frequently  takes 
the  place  of  the  stomach-tube.  In  the  advanced  stages  of 
gastric  catarrh  the  walls  of  the  stomach  thicken  while  the 
glandular  structures  atrophy.  This  form  of  practically  in- 
curable stomach-trouble  is  often  found  in  drunkards. 

Goitre. — In  the  simple  variety  of  the  affection  the  use 
of  galvanism  (wet  sponge  electrodes  on  both  sides  of  the 
neck,  negative  over  the  growth,  ten  to  twenty  milliam- 
peres  for  ten  minutes  every  other  day),  may  be  tried.  Some 
recommend  cataphoric  application  of  saturated  solution  of 
potassium  iodide  by  means  of  a  wet  cotton-pad  or  piece  of 
blotting  paper  with  negative  pole,  fifteen  to  twenty-five  mil- 
liamperes  for  ten  to  fifteen  minutes  every  other  day.  Neg- 
ative electrolysis  by  means  of  needles  thrust  into  the  growth 
is  not  without  danger  (slough,  suppuration,  erysipelas,  hem- 
orrhage, etc.)  The  effects  of  vibration  in  the  interscapular 
region  and  also  to  the  goitre  direct,  recommended  by  some, 
are  largely  illusory.  A  small  positive  static  spray  applied 
locally  has  been  known  to  be  beneficial.  Tight  collars  and 
corsets  should  be  discarded. 

In  exophthalmic  goitre  the  outlook  is  by  no  means  as 
gloomy  as  many  of  the  authors  would  have  us  believe.  The 
enlarged  thyroid  gland  can  be  treated  as  indicated  ab;>ve. 
Faradization  of  the  vagus  if  the  heart-beat  is  weak,  gal- 
vanization of  the  vagus  if  the  heart  is  irregular,  are  useful. 
To  control  a  tumultuous  heart,  vibration  in  the  interscapular 


THERAPEUTIC  INDEX.  411 

region  and  tapotement  over  the  precordial  space  can  be  ad- 
ministered. High-frequency  applications  along  the  spine 
and  over  the  temples  and  the  forehead  may  be  administered 
to  restore  the  nervous  equilibrium.  Positive  static  insula- 
tion is  useful  in  many  cases.  Positive  head  spray  has  a 
tendency  to  relieve  vascular  pressure  in  the  eyes.  Pressure 
over  occipital  region  has  a  fine  effect  in  cases  of  pain 
in  the  head  and  in  the  eyes.  The  general  health  of  the  patient 
should  not  be  lost  sight  of.  Many  nervous  symptoms  in 
these  cases  are  the  result  of  auto-intoxication  from  the  in- 
testinal canal.  Sun-baths  are  excellent  in  these  cases.  (See 
FUNCTIONAL  DISORDERS.) 

Gonorrhea  is  the  type  of  a  self-limited  disease  with  a 
well-marked  tendency  towards  recovery,  if  not  meddled 
with.  There  is  no  doubt  that  most  cases  of  protracted 
specific  urethritis.  chronic  gonorrhea,  gleet,  etc.,  are  due  to 
misapplied  methods  of  treatment.  The  inflamed  mucosa 
should  be  left  severely  alone.  In  the  latter  stages  of  the 
disease,  when  the  discharge  has  practically  ceased,  clear, 
warm  water  should  be  used  by  way  of  injection  or  irrigation. 
Puring  an  attack  of  gonorrhea  the  patient  should  abstain 
from  all  alcohol,  tobacco,  meat,  eggs,  coffee  and  tea.  He 
should  be  encouraged  to  drink  water  frequently  and  co- 
piously. He  should  observe  absolute  cleanliness  about  his 
person.  Immersion  of  the  penis  in  very  hot  or  cold  water 
will  usually  relieve  local  irritation  or  pain.  The  diet  should 
be  continued  for  one  or  two  weeks  after  the  discharge  has 
ceased.  Colon-irrigation,  hot  sitz-baths  and  general  elim- 
ination through  the  skin  are  indicated  throughout  the 
course  of  the  disease.  After  the  acute  stage  the  high-fre- 
quency current  and  mild  vibration  may  be  used  over  the 
pubes  and  perineum  to  stimulate  healthy  local  reaction.  In 
chronic  gonorrhea  positivej^lectrolysis  (very  mild)  by 
means  of  a  sound  or  high-frequency  applications  by  means 
of  a  urethral  vacuum  electrode  has  been  found  serviceable. 
Gonorrheal  rheumatism  is  referred  to  under  the  head  of 
RHEUMATISM. 


412  MODERN  PHYSIO-THERAPY. 

Gout. — The  systemic  treatment  of  a  case  of  gout  should 
be  conducted  along  the  lines  indicated  under  the  head  of 
RHEUMATISM.  Locally  dry  heat,  massage,  vibration  and 
electricity  as  suggested  under  the  same  head  are  serviceable. 
The  dietetic  management  is  of  the  greatest  importance. 
Johann  Schroth  gave  his  gouty  patients  dry  bread  to  eat 
and  clear  water  to  drink.  Locally  he  used  hot  moist  com- 
presses and  applied  massage  to  the  contiguous  territory. 
His  results  won  for  him  an  international  reputation.  In 
convalescent  cases  powerful  derivation  by  packs  applied  to 
the  feet  or  walking  in  the  wet  grass  is  beneficial.  General 
and  local  vapor-baths  are  serviceable  in  many  cases.  The 
diet  suggested  under  the  head  of  RHEUMATISM  must  be 
faithfully  adhered  to  for  a  long  time.  The  static  brush-dis- 
charge (wooden  electrode)  is  a  good  local  anodyne  and  can 
be  given  daily  for  fifteen  minutes.  Depletion  by  leeches  is 
not  infrequently  necessary.  Bier's  stasis  might  be  indicated 
in  obdurate  cases. 

Granulated  Eyelids. — Trachoma  is  best  treated  by 
slowly  moving  a  copper-tip  electrode  (positive)  over  the  af- 
fected surface  for  two  or  three  minutes  with  a  current- 
strength  of  two  to  four  milliamperes.  A  sponge  electrode 
(negative)  is  held  in  the  patient's  hand.  Treatment  can 
be  given  once  or  twice  a  week.  Negative  electrolysis,  with 
needle  in  each  granule,  positive  sponge-electrode  in  hand, 
is  recommended  by  some.  Finsen-rays  (dermo-lamp)  some- 
times give  relief  (fifteen  minutes  every  other  day).  A.  C. 
Geyser  everts  the  lid,  secures  it  in  position  by  adhesive 
strips,  places  a  piece  of  sheet-lead  with  a  suitable  perfora- 
tion in  front  of  the  face  and  makes  X-ray  exposures  for  five 
minutes  every  two  or  three  days.  After  five  or  six  treat- 
ments a  reaction  sets  in,  whereupon  high-frequency  treat- 
ments with  a  dull-pointed  vacuum-electrode  are  given  for 
three  to  five. minutes  every  day  or  two  for  two  or  three 
weeks.  It  is  important  to  protect  the  eyeball. 

Headache. — Always  a  symptom.  (See  AUTO-INTOXICA- 
TION, DYSPEPSIA,  REFLEX  DISORDERS,  FUNCTIONAL  DISOR- 


THERAPEUTIC  INDEX.  413 

DERS,  etc.)  Symptomatic  relief  can  be  obtained  from  pres- 
sure over  back  of  neck  and  head,  pressure  over  temples  and 
forehead,  massage  of  temples  and  forehead,  suggestion  of 
sleep,  positive  static  crown-breeze.  (See  PAIN  and  NEU- 
RALGIA. ) 

Hemorrhage. — The  treatment  depends  on  the  cause, 
character  and  location  of  the  hemorrhage.  If  the  site  is 
accessible,  pressure,  heat,  cold  or  ligation  might  be  required. 
If  the  bleeding  vessels  are  inaccessible,  surgical  interference 
might  be  necessary.  The  more  common  forms  of  hemor- 
rhage encountered  in  general  practice  are : 

EPISTAXIS. — In  many  instances  epistaxis  is  a  therapeutic 
measure  adopted  by  nature  to  counteract  intra-cranial  con- 
gestion. If  bleeding  persists,  apply  copper-electrode  to 
bleeding  cavity  (positive,  ten  to  twenty  milliamperes,  five 
to  fifteen  minutes,  negative  sponge  nape  of  neck.)  Make 
patient  sit  up.  Apply  cold  compresses  to  forehead,  temples 
and  back  of  neck.  Cold  applications  to  the  nose  and  the 
introduction  of  small  pieces  of  ice  are  proper.  In  mild  cases 
let  the  patient  lie  down  and  join  his  hands  over  the  occiput. 
Instruct  him  to  breathe  deeply  and  hold  his  breath  as  long 
as  possible.  In  threatening  cases  apply  a  cold,  moist  pack  to 
the  lower  extremities. 

HEMOPTYSIS. — Patient  should  be  at  rest,  lying  down 
with  head  and  shoulders  slightly  elevated.  If  bleeding  is 
profuse,  improvise  a  hot  vapor-bath  from  the  feet  to  the 
stomach.  Technique  similar  to  that  which  is  given  under 
the  head  of  FEVER.  Hot  applications  to  the  lower  extrem- 
ities up  to  the  iliac  crest,  frequently  renewed,  answer  equally 
well.  If  the  hemorrhage  is  slight  the  cold,  moist  pack  from 
the  feet  to  the  umbilicus  is  better.  A  hot  compress  should 
be  kept  to  the  feet.  The  object  of  all  these  applications  is 
to  lessen  the  blood-pressure  in  the  lungs  by  drawing  the 
blood  to  the  lower  extremities.  Cold  compresses  to  the  back 
of  the  neck  and  the  chest  are  useful.  Diet  should  consist  of 
cold  liquid  food.  Swallowing  small  particles  of  ice  is  very 
serviceable. 


414  MODERN  PHYSIO-THERAPY. 

HEMATKMKSIS. —  Patient  should  be  at  rest  in  the  hori- 
zontal position.  Swallowing  small  pieces  of  ice  is  benefi- 
cial. Cold  compress  on  the  stomach,  derivating  pack  to 
the  lower  extremities.  The  general  regime  does  not  differ 
from  that  in  cases  of  hemoptysis. 

CKKEBRAI,  HKMOKKHAGK  (Aroru-;\Y.) — Patient  should 
be  p'aced  on  his  side  to  prevent  the  tongue  and  the  secre- 
tions from  dropping  into  his  air-passages.  Cold  applications 
to  the  head  and  back  of  the  neck  should  be  made.  Pressure 
over  back  of  neck  is  useful.  Decrease  intra-cranial  blood- 
pressure  by  derivating  applications  as  indicated  in  the  treat- 
ment of  hemoptysis  given  above.  Powerful  derivation  to 
the  lower  extremities  and  to  the  abdominal  wall  should  be 
practiced  as  given  in  the  chaper  on  THE  TIIJ:RAIM:UTIC  EF- 
FECTS OF  HEAT  AND  COLD.  This  can  be  accomplished 
by  hot  baths,  dry-heat  cylinder,  packs,  vapor-bath, 
etc.,  etc.  The  vapor-bath  described  under  the  head 
of  FEVER  is  excellent  as  a  cerebral  depletent.  The  sec- 
ondary object  in  all  these  depleting  applications  is  to  stim- 
ulate skin-activity  whereby  the  proportion  of  liquids  in  the 
body  is  lessened  and  the  absorptive  activity  of  the  organism 
is  thus  given  a  powerful  impetus.  There  is  no  method  of 
treatment  in  cases  of  cerebral  hemorrhage,  cerebral  conges- 
tion, cerebral  toxaemia,  etc.,  and  their  concomitant  symp- 
toms (coma,  violent  headache,  severe  nervous  phenom- 
ena, etc.)  that  equals  in  promptness  and  intensity  of  pal- 
liative and  curative  efficacy  the  "derivating"  pack  or  bath 
whereby  the  blood  mass  is  directed  toward  the  lower  por- 
tions of  the  body.  It  is  universally  applicable  in  all  cases 
in  which  it  is  desirable  to  relieve  the  brain  of  pressure.  This 
form  of  treatment  comes  first  in  point  of  usefulness  in 
cases  of  cerebral  hemorrhage  and  also  in  cases  of  typhoid 
coma.  In  the  former,  blood-pressure  is  reduced,  bleeding 
steps  and  absorption  of  the  clot  begins.  In  the  latter,  the 
passive  congestion  is  counteracted,  the  local  toxaemia  less- 
ens and  brain-function  is  re-established.  Enemata  should 
be  frequently  and  cautiously  given  without  moving  the  pa- 
tient out  of  the  horizontal  position.  Catheterize  the  patient 


THERAPEUTIC  INDEX.  415 

as  soon  as  practicable.  If  the  patient's  face  is  red  and  con- 
gested leeches  should  be  applied  to  the  temples  and  venesec- 
tion practiced. 

The  after-treatment  consists  in  frequent  general  luke- 
warm sponge-baths  and  massage  to  keep  the  skin  active. 
A  weak  galvanic  current  (one  electrode  on  each  mastoid 
process  or  positive  pole  moved  over  temples  and  forehead, 
negative  pole  in  back  of  the  neck)  helps  absorption.  Par- 
alyzed muscles  should  be  faradized.  Food  should  be  prin- 
cipally non-nitrogenous  and  not  solid.  Static  positive  in- 
sulation is  useful.  It  might  be  well  to  add  that  persons 
who  are  prone  to  suffer  from  congestion  of  the  head  (apo- 
plectic tendency)  can  do  nothing  better  than  to  increase 
the  circulation  in  the  lower  extremities  by  frequently  walk- 
ing in  the  wet  grass  or  fresh  snow.  (Kneipp.)  It  is  a 
prophylactic  of  great  virtue. 

UTERINE  HEMORRHAGE. — Therapeutic  directions  are 
given  under  the  head  of  METKORRHAGIA.  If  uterine  hem- 
orrhage occurs  post-partum,  the  employment  of  vigorous 
massage  to  force  contraction  of  the  uterine  body  is  very  es- 
sential. Faradization  with  a  tolerably  strong  current  (ab- 
domen and  cervix)  is  often  very  helpful. 

INTESTINAL  HEMORRHAGE. — In  thin  subjects  make  cold 
applications  to  the  abdomen,  hot  applications  to  the  lower 
extremities.  In  fat  persons  a  cold,  moist  pack  over  the  ab- 
domen is  preferable  to  the  cold  compress.  The  latter  would 
not  penetrate  while  the  former  would  draw  blood  away  from 
the  intestines  and  assemble  it  in  the  abdominal  wall..  Abso- 
lute rest  is  imperative.  In  thin  persons  the  galvanic  cur- 
rent (positive  abdomen,  negative  on  back)  can  be  used  with 
benefit.  In  fat  persons  the  faradic  current  might  serve  to 
contract  muscular  tissue  and  in  this  way  counteract  hem- 
orrhage. It  is  wise  to  withhold  liquids  even  if  the  patient 
complains  of  thirst.  Coagulation  is  thus  favored.  A  firm 
abdominal  bandage  is  sometimes  useful.  All  these  direc- 
tions can  be  advantageously  employed  in  intestinal  hemor- 
rhage occurring  as  a  complication  of  typhoid  fever. 


416  MODERN  PHYSIO-THERAPY. 

Hemorrhoids. — Regulate  the  patient's  mode  of  liv- 
ing. Exclude  meat,  spices,  salty,  sour  and  highly  seasoned 
food  from  the  patient's  diet.  The  latter  should  consist  of 
wheat-bread  (from  the  whole  grain),  rye-bread,  Schrot- 
brot,  Pumpernickel,  green  vegetables,  raw  fruit,  cider,  fruit- 
jam,  buttermilk.  Fresh  water  at  every  meal.  Irrigation  of 
the  colon  carefully  performed  is  valuable.  The  patient 
should  avoid  tight-fitting  clothes  (corsets,  etc.) ,  Massage  of 
the  stomach  and  bowels,  Swedish  movements  to  exercise  the 
abdominal  muscles,  horseback  exercise,  mountain-climbing, 
gardening,  are  indicated.  Hot  sitz-baths,  vapor-baths,  ab- 
dominal hot  pack,  hot  foot-bath  before  retiring,  are  very 
serviceable.  Locally  galvanism  (positive  copper-electrode 
to  pile,  negative  to  abdomen,  ten  to  twenty  milliamperes 
for  five  to  fifteen  minutes  every  day  or  two).  Hard  exter- 
nal piles  should  be  treated  with  needle  (negative  electrol- 
ysis), hemorrhoidal  varix  with  positive  electrolysis.  (See 
VARIX.)  Vibration  by  means  of  a  rectal  attachment  some- 
times is  useful  in  irritable  hemorrhoids  which  are  intact.  Vi- 
bration over  lumbar  region,  perineum  and  abdomen  relieves 
congestion.  High-frequency  applications  by  means  of  a  rec- 
tal vacuum  electrode  answer  well  in  some  cases. 

Hepatic  Cancer. — Treatment,  is  purely  symptomatic. 
Therapeutic  suggestions  are  given  under  the  head  of  Hii- 
PATIC  CIRRHOSIS,  DYSPEPSIA,  GASTRIC  CANCER. 

Hepatic  Cirrhosis. — The  enforcement  of  the  Schroth 
diet  (stale  bread,  rice,  oatmeal  in  small  quantities,  but  little 
liquids,  no  alcohol)  and  the  dehydration-method  of  Oertel 
(see  VALVULAR  DISEASES  OF  THE  HEART)  hold  out  fairly 
good  prospects  in  the  first  stages  of  the  disease.  Cold  moist 
packs  on  the  abdomen,  vibration  and  massage  of  the  ab- 
domen and  daily  irrigation  of  the  colon  are  splendid  ad- 
juncts to  the  treatment.  A  large  positive  pad-electrode 
over  the  liver,  negative  to  the  feet  and  hydro-therapeutic 
applications  to  the  lower  extremities  to  unload  the  stagnant 
portal  system,  are  valuable.  The  patient  should  avoid 
starches  and  fats.  In  the  later  stages  of  the  disease  the 


THERAPEUTIC  INDEX.  417 

treatment  is  purely  symptomatic.  Diet,  derivating  water- 
applications  to  the  lower  extremities,  massage  of  the  stom- 
ach, colon-irrigation,  sun-baths  and  plenty  of  fresh  air  are 
the  necessary  conditions  of  treatment.  Vibration  of  the 
liver  is  sometimes  beneficial  in  the  early  stages  of  the  dis- 
ease, but  injurious  in  the  advanced  stages. 

Hydrocele. — Xeiswanger  recommends  galvano-puncture 
(negative  in  scrotum,  positive  on  abdomen,  current  grad- 
ually increased  to  forty  milliamperes  for  five  minutes).  A 
different  plan  is  to  draw  off  the  fluid,  then  inject  one-third 
as  much  strong  solution  of  KI,  introduce  large  needle  con- 
nected with  positive  pole,  negative  pole  on  abdomen,  ten 
minutes,  galvanism  gradually  increasing  until  fifteen  to 
twenty  milliamperes  are  reached. 

Hypochondriasis  is  a  disorder  of  the  nervous  system 
produced  by  disturbances  of  alimentary  function  and  is 
mostly  found  in  men.  It  is  closely  allied  to  the  hysteria  of 
the  female.  (See  FUNCTIONAL  DISORDERS,  REFLEX  DISOR- 
DERS, DYSPEPSIA,  NEURASTHENIA.) 

Hysteria  may  be  defined  "a  condition  of  the  nervous 
system  of  women,  characterized  by  a  suspension  or  impair- 
ment of  initiative  will-power  and  by  the  dominant  influence 
of  imagination  or  emotion  over  the  sensory  and  motor 
functions."  It  corresponds  to  the  hypochondriasis  of  men. 
The  etymology  of  the  word  "hysteria"  points  to  the  sexual 
organs  as  the  primary  seat  of  the  disorder,  while  the  term 
"hypochondriasis"  suggests  the  digestive  organs.  The  lit- 
eral meaning  of  the  two  words  shows  the  wisdom  of  the 
ancients  whose  primitive  notions  concerning  etiology  and 
pathology  have  in  not  a  few  instances  outlived  the  many 
upheavals  in  medical  lore  that  have  marked  the  history 
of  the  healing  art.  In  treating  functional  diseases  of  the 
nervous  system,  always  look  to  the  sexual  organs  first  and 
to  the  stomach  second  if  the  patient  be  a  woman.  In  a  man 
reverse  the  order  named  and  think  of  the  stomach  first  and 
then  of  the  sexual  apparatus.  Woman  is  more  a  creature  of 
sex  than  man.  The  manifestations  of  both  hysteria  and 


41S  MODERN 


livpochondriasis  are  probably  symptoms  of  auto-intoxica- 
tion. (See  FUNCTIONAL  DISORDERS,  REFLEX  DISORDERS, 
DYSPEPSIA,  NEURASTHENIA.) 

Try  to  find  out  the  cause  and  remove  it,  if  such  is 
possible.  Let  the  environments  of  the  patient  be  ideally 
hygienic  (sunlight,  fresh  air)  and  give  due  attention  to  the 
four  emunctories.  Suggestion  is  a  most  powerful  agent 
for  good  in  the  management  of  a  case  of  hysteria.  It 
should  be  given  through  the  mind  of  the  patient  by  the 
presence  and  by  the  moral  and  personal  influence  of  the 
physician.  The  patient's  surroundings-  should,  through  the 
special  senses,  serve  to  accentuate  the  suggestion.  Every- 
thing should  be  done  to  rouse  and  fortify  the  patient's 
will-power  without  hurting,  frightening  or  shaming  her. 
The  patient  should  be  removed  from  the  presence  of  people 
and  from  their  meddlesome  influence.  Sometimes  a  patient 
will  have  to  be  put  to  bed.  Weir  Mitchell's  plan  of  isola- 
tion, massage,  faradism  and  forced  feeding  (Mastkur)  has 
but  little  to  recommend  it. 

Massage  of  the  stomach  and  abdomen  is  very  beneficial 
in  most  cases.  It  can  be  combined  with  rapid  and  light 
vibration  of  the  whole  spine,  especially  the  dorsal  and  lum- 
bar regions.  If  the  patient  is  anemic,  general  massage  and 
a  daily  protracted  sun-bath  can  be  given.  If  the  case  pre- 
sents violent  symptoms,  the  positive  static  spray  along  the 
spine  will  be  found  very  serviceable.  If  the  patient  inclines 
toward  introspection  and  melancholia,  the  negative  static 
spray  or  the  negative  static  insulation  are  indicated.  If  the 
patient's  condition  is  associated  with  menstrual  disturbances 
or  sexual  aberrations,  vibration  or  firm  pressure  over  t!i? 
ovaries  sometimes  gives  relief.  In  many  cases  Swedish 
movements  are  followed  by  improvement.  Forcibly  rais- 
ing and  rotating  the  arms  and  legs  in  the  standing  or  lying 
posture  serves  to  deplete  the  bodv  toward  the  periphery. 
Eventually  these  movements  can  be  executed  with  an  at- 
tendant resisting.  Warm  applications  over  the  abdomen, 
while  a  cold  moist  pack  is  applied  to  the  lower  extremities, 


THERAPEUTIC  INDEX.  419 

is  frequently  of  service.  Cold  douches  over  the  spine  and 
over  the  lower  extremities  are  useful.  In  some  cases  of 
paresis  warm  baths  (carrying  a  mild  faradic  current)  have 
a  good  effect.  Hysterical  paralyses  require  suggestion,  lo- 
cally vibration,  faradization  and  massage.  The  high-fre- 
quency current  applied  by  means  of  a  vacuum-tube  is  a 
splendid  adjunct,  especially  in  aphonia  and  dysphagia.  The 
diet  of  a  patient  should  be  vegetable  for  well-nourished  in- 
dividuals, nitrogenous  for  frail  and  anemic  subjects. 

Hysteria  is  distinctly  the  disorder  of  an  individual  nerv- 
ous system.  It  is  impossible  to  treat  a  case  of  this  kind 
without  painstaking  individualization.  There  is  no  disease 
where  so  much  depends  on  the  personal  equation  of  the  phy- 
sician as  in  hysteria.  Suggestion  is  by  al!  odds  the  foremost 
therapeutic  agent.  It  should  be  practiced  persistently  in 
these  cases.  Hysteria  offers  a  fruitful  field  for  studies  in 
animal  magnetism.  The  "laying  on  of  hands"  as  practiced 
by  Charcot,  Bernheim  and  Fuchs  has  demonstrated  the 
clinical  possibilities  of  animal  magnetism  in  cases  of  hys- 
teria and  allied  disorders.  Under  the  head  of  LOCOMOTOR 
AT  AX  i  A  the  movement-cure  of  Frankel  is  discussed.  The 
patient  who  has  lost  co-ordination  is  taught  to  perform  cer- 
tain muscular  acts  mechanically.  The  suggestive  therapy 
in  hysteria  is  analogous.  It  educates  a  mind  whose  co-ordi- 
native  power  has  been  lost,  to  functionate  in  a  sort  of  me- 
chanical way  in  keeping  with  certain  suggestions.  If  there 
are  remediable  features  about  the  case,  they  should  be  met 
by  suitable  means.  In  young  girls  mental  hygiene  and  reg- 
ulation of  the  menstrual  function  should  be  the  object  of 
treatment.  A  love-hungry  old  maid  who  has  become  hys- 
terical should  be  married  off  to  re-establish  the  balance.  In 
hysterical  widows  the  regime  is  similar.  If  a  married  wo- 
man is  denied  the  privilege  of  motherhood,  the  case  can  of- 
ten be  cured  by  directing  the  misspent  energy  into  proper 
channels.  Such  a  woman  should  find  an  object  in  life  to 
take  the  place  of  a  child  of  her  own  flesh  and  blood.  Let 
her  adopt  a  child.  The  principal  thing  is  to  find  an  object 


420  MODERN  PHYSIO-THERAPY. 

to  act  as  a  constant  source  of  suggestion  to  a  hysterical  sub- 
ject. Interest  her,  arouse  latent  ambition.  Stimulate  force 
and  let  her  spend  it.  Therein  lies  the  psychology  of  Wo- 
men's Rights  Associations,  Temperance  Societies,  etc.  So- 
ciologically they  might  be  a  nuisance,  therapeutically  they 
serve  an  admirable  purpose  in  many  cases. 

Incontinence  of  Urine. — Cold  douches  to  the  spine,  vi- 
bration over  the  lumbar  vertebrae  and  regular  evacuation  of 
the  bowels  are  helpful.  Mild  vibration  over  perineum  in 
boys  is  advised  by  some,  but  seems  of  doubtful  efficiency 
(might  cause  greater  evils).  Galvanism  (ten  milliamperes, 
positive  over  pubes  and  spine  by  means  of  a  bifurcated  elec- 
trode, negative  to  feet)  or  faradism  (lumbar  region  and 
pubes)  are  recommended  by  some.  Static  spray  (positive) 
over  sacral  and  pubic  regions  might  be  tried.  Try  foot- 
baths containing  negative  pole  and  warm  wet  pad  around 
pelvis,  connected  positively,  mild  galvanic  current  every 
day.  Local  causes  should  be  inquired  into,  also  condition  of 
general  health.  (See  HYSTERIA  and  FUNCTIONAL  DISOR- 
DERS. ) 

Inflammation  (Acute). — The  amount  of  blood  which 
is  carried  to  any  part  is  regulated  by  the  vaso-motor  (sym- 
pathetic) nerves  in  keeping  with  the  physiological  needs 
of  the  part.  Increased  need  calls  for  increased  blood-sup- 
ply (physiological  hyperemia).  Increased  need  may  be 
brought  about  by  increased  activity  (function)  of  the  part 
or  by  the  presence  of  some  element  by  which  the  integrity 
of  the  part  as  such  is  endangered  (trauma,  septic  matter, 
etc.)  To  protect  the  part,  an  enormous  increase  in  the  ar- 
terial supply  takes  place.  This  means  over-nutrition,  more 
active  local  metabolism  and  oxidation.  Incidentally  nature 
isolates  the  part  by  surrounding  it  with  a  wall  made  up 
of  congested  blood-vessels,  lymphatics  and  infiltrated  con- 
nective tissue.  In  this  way  the  system  at  large  is  protected 
against  invasion.  Locally,  there  is  heat,  pain  and  swell- 
ing. If  the  affected  part  is  near  the  surface,  the  skin  will 
appear  red.  Vaso-motor  control  is  lost  and  changes  occur 


THERAPEUTIC  INDEX.  421 

in  the  contents  of  the  blood-vessels  (exudation  of  serum, 
transmigration  of  white  blood  corpuscles),  and  new  cell- 
formation  outside  of  the  vessels  takes  place.  This  com- 
posite local  process  is  called  inflammation.  Eventually 
vaso-motor  control  reasserts  itself,  absorption  takes  place 
and  the  normal  condition  again  supervenes.  If  the  resist- 
ing power  of  the  part  is  not  equal  to  the  ordeal  of  so  severe 
a  local  reaction,  the  part  may  die  molecularly  or  en  masse. 
Thus,  inflammation  may  terminate  in  ulcer  or  sloughing. 
If  pus-germs  are  present,  the  inflammation  may  merge  into 
an  abscess  (localized  suppuration).  The  agencies  which 
may  cause  a  part  to  become  inflamed  are :  vicious  sys- 
temic conditions,  irritation  by  intense  heat  or  cold,  infection 
by  germs,  destruction  of  tissue  by  injuries  of  any  kind. 
The  system  at  large  may  co-operate  with  the  affected  part 
by  intensifying  general  metabolism.  In  this  way  a  (local) 
'inflammation  may  cause  a  (general)  fever.  Biologically 
speaking,  both  inflammation  and  fever  are  restorative 
agents.  In  this  sense  we  may  say  that  inflammation  is  to  a 
part  what  fever  is  to  the  general  system. 

There  are  certain  therapeutic  principles  which  hold  good 
in  all  cases  of  inflammation.  Clinically  we  may  recognize 
three  stages  of  inflammation,  to  wit:  congestion,  exudation 
and  restoration  (absorption). 

CONGESTION. — During  this  stage  our  efforts  should  be 
directed  towards  aborting  inflammation  by  dispersing  the 
blood-mass.  The  older  physicians  practiced  depletion  by 
venesection.  The  same  result  without  loss  of  blood  can  be 
achieved  by  hydo-therapeutic  methods  (derivation).  If  the 
congested  area  is  accessible,  practice  massage  (effleuragc 
centripetal)  on  the  healthy  tissues  near  the  periphery  of 
the  inflamed  portion  in  order  to  stimulate  absorption.  The 
fundamental  therapeutic  principle  during  congestion  in  any 
part  of  the  body  is :  Deplete  the  region  by  causing  the  blood 
to  be  drawn  to  some  distant  part.  The  modus  operandi 
is  exhaustively  discussed  under  the  head  of  HYDRO- 
THERAPY. 


422  MODERN    I'HYSIO-TI;KKAPY. 

The  local  treatment  of  the  congested  part  is  of  great 
clinical  significance.  Cupping  and  the  use  of  leeches  are  de- 
pletent  measures.  The  ice-bag  is  a  much  abused  becati.s-e 
ill-understood  measure.  If  the  inflamed  part  is  near  or  at 
the  surface  and,  therefore,  easily  reached  by  thermic  influ- 
ences, the  continuous  application  of  ice  can  never  be  >roper, 
c.  g.  during  the  congestive  stage  of  appendicitis  in  a  tol- 
erably thin  patient.  To  freeze  the  part  means  to  suspend 
all  evidences  of  vitality.  Blood-vessels  are  contracted,  the 
skin  becomes  inactive,  the  local  temperature  drops  below 
the  point  of  health.  Even  granting  that  in  this  way  the  in- 
flammation has  been  literally  frozen  out,  is  it  possible  for 
the  part  to  recover  without  some  damage  having  been  done 
to  its  functional  tone  (nutrition)  ?  The  vaso-motor  nerves 
are  irreparably  damaged  by  the  devitalizing  effect  of  in- 
tense cold.  The  part  is  bound  to  lose  some  of  its  resisting 
power  and  congestion  and  inflammation  are  more  than 
likely  to  recur.  With  the  local  physiological  tone  below 
par,  pus-germs  have  a  splendid  soil  for  development.  The 
continuous  application  of  ice  lessens  the  resisting  power 
cf  the  part,  favors  recurrence  of  local  circulatory  disturb- 
ance and  facilitates  suppuration.  This  is  well  shown  by 
the  clinical  history  of  not  a  few  cases  of  appendicitis.  The 
direct  action  of  intense  cold  on  an  inflamed  part  is  n  -t 
conducive  to  restoration  without  damage.  The  more 
healthy  tissue  intervenes  between  the  ice-bag  and  the  in- 
flamed area,  the  less  objection  there  is  on  this  score.  In  a 
fat  patient  suffering  from  congestion  in  the  right  iliac 
space,  the  application  of  ice  is  less  objectionable  than  it 
would  be  in  a  thin  person.  The  same  may  be  said  of  the 
use  of  the  ice-bag  on  the  head  and  on  the  chest.  The  cal- 
varium  and  thorax  neutralize  by  their  interposition  the  ob- 
jectionable feature  of  the  intense  cold.  In  inflamed  joints 
the  continued  application  of  ice  is  often  directly  responsible 
for  disastrous  results.  This  holds  good  more  especially  in 
children. 

Priessnitz   was   in  the  habit  of  causing  cold  water  to 


THERAPEUTIC  INDEX.  423 

flow  over  territory  contiguous  to  the  inflamed  area.  In 
this  way  stimulation  of  the  surroundin  ;  tissues  was  pro- 
duced and  a  mild  depletent  action  followed.  Moderate  heat 
(like  the  heat  of  a  poultice)  or  moderate  cold  (like  the  tem- 
perature of  well-water)  are  therapeutically  available.  Both 
are  stimulants,  the  cold  application  more  so  than  the  warm. 
]n  choosing  between  them  the  comfort  of  the  patient 
should  be  consulted.  Whichever  application  gives  relief 
should  be  chosen.  Ordinarily  the  hot  application  does  well 
in  cases  where  the  inflammatory  action  is  not  cutaneous. 
The  more  superficial  the  inflammation,  the  lower  should 
be  the  temperature  of  the  application.  It  should,  however, 
never  be  the  temperature  of  ice  or  ice-water.  The  indica- 
tions for  massage  and  vibration  increase  in  proportion  to 
the  distance  of  the  inflamed  area  from  the  skin.  It  should 
be  remembered  that  the  greatest  benefit  is  derived  from 
manipulation  of  the  contiguous  tissues.  For  obvious  rea- 
sons intense  heat  (dry-heat  cylinder)  is  available  for  the 
purpose  of  depleting  deep  structures  by  drawing  blood  to 
the  surface  and  stimulating  the  latter.  In  this  way  its 
action  would  be  analogous  to  the  modus  operandi  of  a  hot 
poultice.  Fine  therapeutic  effects  can  at  times  be  produced 
by  modifying  the  application  of  the  principle  of  derivation 
with  the  aid  of  the  dry-heat  cylinder.  Deplete  a  congested 
area  by  baking  a  neighboring  part,  e.  g.  by  giving  a  dry- 
heat  treatment  to  the  femoral  region  and  knee -for  the  pur- 
pose of  relieving  a  cellulitis  in  the  foot.  Exposure  to  the 
Minin  light  has  a  depletent  effect  if  the  inflammation  is 
comparatively  deep-seated.  The  physiological  principles 
involved  are  plain. 

If  the  inflamed  region  is  comparatively  superficial  and 
not  very  extensive,  good  effects  can  often  be  produced  by 
placing  a  (positive)  sponge-electrode  directly  over  it  (neg- 
ative pole  at  some  distance)  and  allowing  a  mild  galvanic 
current  to  pass  through  it.  A  positive  static  spray  is  very 
serviceable. 

EXUDATION. — When  the  second  stage  of  inflammation 


424  MODERN  PHYSIO-THERAPY. 

has  begun,  it  is  no  longer  possible  to  abort  the  process  by 
depletion.  On  the  contrary,  the  condition  is  one  of  stasis. 
The  blood  is  partially  disintegrated  by  exudation  of  some 
of  its  aqueous  elements  and  a  loss  of  some  of  its  corpuscular 
constituents.  During  this  stage  pressure  or  massage  is 
useful  if  the  part  is  accessible,  the  object  being  to  stimulate 
the  absorbent  vessels.  Alternate  applications  of  heat  and 
cold  are  a  powerful  alterative.  Pressure  may  be  accom- 
plished by  a  bandage,  adhesive  strips,  by  bags  of  sand  or 
shot.  Massage  and  vibration  of  the  surrounding  parts, 
especially  between  the  inflamed  area  and  the  heart,  are  very 
useful.  It.  stands  to  reason  that  in  inaccessible  inflamma- 
tions (meningitis,  pneumonia,  etc.)  these  direct  therapeutic 
methods  are  not  applicable,  although  much  good  can  be 
done  by  increasing  metabolism  in  distant  parts  or  in  the 
whole  system.  (See  PNEUMONIA.)  Ordinarily,  warm  ap- 
plications are  best  adapted  in  the  second  stage  of  in- 
flammation. 

The  faradic  current  can  be  employed  during  the  second 
stage  of  inflammation.  It  contracts  muscular  tissues  and 
in  this  way  can  be  made  to  compress  an  inflamed  part. 
The  high-frequency  current  has  been  known  to  shoVten 
the  stage  of  exudation  and  hasten  absorption.  Good  effects 
can  often  be  produced  by  placing  the  inflamed  part  between 
the  poles  of  a  galvanic  circuit.  The  applications  should  be 
mild,  short  -and  frequent.  Polarity  should  be  reversed 
with  each  succeeding  application. 

ABSORPTION,  SUPPURATION,  SLOUGHING. — Restoration  in 
favorable  cases  takes  place  by  absorption.  Hydro-therapy 
again  offers  the  best  means  of  intensifying  and  accelerating 
the  last  stage  of  inflammation.  General  derivation  (com- 
plete cold  moist  pack)  is  indicated  if  the  inflammatory 
area  has  any  extent  at  all.  In  accessible  cases  massage  and 
vibration  along  the  lymphatics  centripetally  are  valuable,  es- 
pecially if  the  affected  area  is  in  the  arm  or  leg.  Central 
vibratory  stimulation  to  promote  absorption  is  useful  as 
an  adjunct  to  local  massage.  If  the  symptoms  of  inflamma- 


THERAPEUTIC  INDEX.  425 

tory  reaction  persist,  especially  pain,  the  formation  of  pus 
may  be  looked  for.  (See  SEPSIS.)  The  result  may  be 
more  or  less  disintegration  of  tissue.  (See  ULCER.)  In 
addition  to  the  surgical  rules  which  must  prevail  in 
these  cases  (incision,  evacuation,  surgical  cleanliness),  the 
circulation  in  the  affected  area 'and  in  the  contiguous  struc- 
tures should  be  stimulated  by  suitable  means.  In  the  treat- 
ment of  the  extremities  the  virtues  of  the  continuous  immer- 
sion in  (flowing)  hot  water  can  not  be  too  highly  spoken  of. 

SYSTEMIC  CONSIDERATIONS. — Fever  is  the  most  con- 
spicuous evidence  of  the  part  which  the  system  at  large 
plays  in  conjunction  with  a  local  inflammatory  condition. 
(See  FEVER.)  The  diet  in  these  cases  should  be  bland, 
easily  digested  and  non-stimulating.  (See  DIET  IN  ACUTE 
FEVERS.)  Even  if  the  local  inflammatory  condition  in- 
volves important  internal  structures  of  vital  significance  in 
the  economy,  a  starvation  diet  will  often  help  to  shorten 
the  inflammation  and  hasten  the  absorption.  Keep  the 
patient's  bowels  open  and  restrict  the  patient  to  dry  bread 
or  crackers,  with  a  little  fruit-juice.  Give  but  little  water. 
,If  the  patient  is  weak,  add  a  little  light  wine  to  the  water. 
A  diet  of  this  kind  for  two  or  three  days  makes  a  deep  im- 
pression en  metabolism.  The  system  is  compelled  to  force 
absorption.  Thus  the  inflammatory  process  is  shortened 
and  its  severity  lessened.  If  the  inflammation  is  the  result 
of  a  systemic  disorder,  the  latter  should  receive  proper 
attention. 

Inflammation  (Chronic). — If,  for  some  reason  or  other, 
an  acute  inflammation  has  not  terminated  in  absorption, 
suppuration  or  sloughing,  but  continues  in  a  mild  degree, 
the  condition  is  called  chronic  inflammation.  It  is  char- 
acterized by  passive  congestion,  thickening  or  hardening 
of  the  tissues  and  a  liability  to  acute  exacerbations.  Even- 
tually changes  occur  in  the  structure  of  the  tissue,  owing 
to  the  altered  conditions  of  nutrition.  The  most  character- 
istic sign  of  a  chronic  inflammation  is  the  absence  of  a  re- 
storative tendency.  The  part  affected  apparently  remains 


426  MODKRN     I'lIYSIO-TKKRAI'Y. 

in  statu  quo.  There  is  no  resisting  power  in  the  affected 
region.  Acute  symptoms  are  likely  to  arise  at  any  time. 
The  structural  changes  may  consist  in  the  formation  of 
cicatricial  tissue,  firm  adhesions,  thickening  of  membranes, 
proliferation  of  connective  or  other  forms  of  low  tissue,  or- 
ganization of  exudates,  etc.  There  may  be  complete  sus- 
pension of  function  owing  to  atrophy  or  destruction  of 
the  functionating  elements,  exaggerated  or  perverted  func- 
tion. At  times  the  chronic  inflammation  begins  and  con- 
tinues as  such.  The  word  "catarrh,"  which  in  the  minds 
of  the  public  has  a  well-established  significance,  refers  to 
these  conditions.  They  may  be  the  local  expression  of  a 
deteriorated  state  of  the  system,  acquired  or  inherited.  They 
may  be  due  to  long-continued  irritation  of  the  part.  This 
irritation  might  be  due  to  the  mistreatment  of  an  acute 
inflammation.  The  catarrhal  conditions  in  the  right  iliac 
fossa  which  are  essentially  chronic  and  after  a  number  of 
acute  exacerbations  might  become  the  culture-soil  of  pus- 
germs,  are  illustrative  of  a  class  of  cases  that  are  not  infre- 
quently produced  by  the  wrong  kind  of  therapeusis,  ?.  g. 
the  continuous  use  of  the  ice-bag.  The  catarrhal  conditions 
in  and  near  the  uterus  are  the  products  of  abuse  (irritating 
vaginal  douches,  cold  douches,  sexual  errors,  etc.),  causing 
changes  in  the  circulation  ar.d  nutrition  of  the  part.  That, 
under  these  conditions,  latent  embryonic  cells  might  be 
stimulated  and  developed,  leading  to  malignant  formations, 
there  seems  to  be  no  reasonable  doubt.  That  this  is  the 
etiology  of  uterine  cancer  seems  to  be  more  than  plausible. 
Chronic  inflammation  or  catarrh  may  gradually  give  rise  to 
atrophy,  hypertrophy,  degeneration  of  diverse  kinds,  hyper- 
plasia,  ulceration,  cicatrization,  exudation,  suppuration  and 
may  be  associated  with  any  number  of  intercurrent 
affections. 

From  a  clinical  point  of  view  chronic  inflammations  or 
catarrhal  conditions  might  be  divided  into  those  which 
involve  inaccessible,  and  those  which  affect  accessible  parts. 
In  the  latter  the  local  treatment  would  necessarily  be  an 
element  of  great  therapeutic  importance. 


THERAPEUTIC  INDEX.  427 

In  cases  of  inaccessible  chronic  inflammations  hydro- 
therapy  enables  us  to  control,  alter,  increase  or  decrease  the 
circulation  in  and  near  the  affected  region  ("derivation"). 
The  possibilities  of  water-applications  are  well-nigh  unlim- 
ited. In  all  cases  of  chronic  inflammations  or  catarrhal 
conditions,  irrespective  of  their  location,  duration,  extent 
or'  severity,  elimination  through  the  cl.in  should  be  the  be- 
ginning of  all  rational  therapy.  A  local  circulatory  dis- 
turbance can  not  exist  for  any  length  of  time  without  in- 
volving the  system  generally.  Sluggish  circulation  in  the 
affected  part  disturbs  the  local  metabolism.  Retained  waste, 
effete  matter  and  combustion-products  gradually  are  ab- 
sorbed from  the  chronically  congested  area  into  the  general 
system,  giving  rise  to  the  thousand  and  cne  possible  forms 
of  auto-intoxication  in  variable  degrees  of  severity.  Thus 
we  get  the  typical  picture  of  a  chronic  ailment,  local  in  its 
pathology  but  constitutional  in  its  symptomatic  expressions. 
Not  infrequently  the  general  symptoms  detract  from  the 
local  disturbance.  Through  the  sympathetic  nervous  sys- 
tem whose  fibers  and  ganglia  are  irritated  by  absorbed  toxic 
piaterial,  an  unending  variety  of  symptoms  might  be  pro- 
duced. (See  FUNCTIONAL  DISORDERS  and  REFLEX  DISOR- 
DERS.) Chronic  inflammatory  conditions  of  the  gastric,  in- 
testinal or  bronchial  mucous  membrane,  of  the  pelvic  cellular 
tissue,  of  the  Schneiderian  and  pharyngeal  membranes,  of 
the  ovarian  tissues,  of  the  connective  and  fibrous  tissue  in  the 
muscles  of  the  back  are  in  this  way  responsible  for  any 
number  or  variety  of  toxemic  symptoms,  erroneously  called 
icflex  symptoms.  The  term  "reflex  symptom"  is  a  much- 
abused  mantle  of  charity  which  covers  a  multitude  of  diag- 
nostic inaccuracies.  Reflex  symptoms,  e.  g.  headache, 
neuralgia,  vertigo,  palpitation  of  the  heart,  malaise,  irri- 
tability, etc.,  etc.,  are  usually  evidences  of  auto-intoxica- 
tion and  require  general  eliminative  treatment.  This  is 
most  emphatically  proper  in  cases  where  an  acquired  or 
inherited  vicious  condition  of  the  system  prevails.  In  all 
chronic  conditions  the  first  step  in  the  treatment  should  be 


428  MODERN  PHYSIO-THERAPY. 

to  open  the  avenues  of  excretion.  Colon-irrigation  should 
be  practiced  twice  or  three  times  a  week.  The  skin  should 
be  kept  active  by  general  packs,  dry-heat  baths,  vapor- 
baths,  etc.  On  general  principles  it  might  be  stated  that 
in  most  chronic  conditions  excretion  is  sluggish  and  reaction 
imperfect.  Therefore,  the  hot  applications  (dry-heat  cyl- 
inder, vapor-bath)  are  preferable  to  the  more  exacting 
cold  moist  packs.  The  latter  are  to  be  substituted  after 
the  system  has  become  habituated  to  active  metabolism. 
General  massage  should  be  added  to  all  general  treatments 
outlined  above.  Dietetic  directions  should  be  given  in  keep- 
ing with  the  physiological  requirements  of  the  individual 
case.  Afebrile  conditions  require  a  preponderance  of  car- 
bohydrates (bread,  Graham-bread,  Schrotbrot,  crackers, 
rice,  oatmeal,  zwieback,  milk-toast,  fresh  fish,  oysters,  pota- 
toes, fresh  fruit  and  vegetables,  with  the  exception  of  peas, 
beans  and  lentils).  The  idiosyncrasies  of  the  patient  and 
individuality  of  the  patient's  stomach  should  be  considered. 
Fresh  water  is  always  proper.  Weak  coffee  and  tea  are  per- 
missible ;  alcoholic  stimulants  are  contra-indicated  in  most 
cases. 

In  view  of  the  vast  importance  of  air  and  light  on 
metabolism,  exercise  in  the  open  air  and  exposure  to  sun- 
light should  be  insisted  upon.  No  sanitarium  for  the  treat- 
ment of  chronic  diseases  is  complete  without  a  solarium. 

Electricity  is  a  splendid  helpmate  in  the  general  treat- 
ment of  chronic  inflammatory  conditions,  the  object  of 
electrical  applications  being  to  aid  in  general  innervation 
and  help  in  the  restoration  of  metabolic  activity.  General 
faradization  is  proper  in  cases  of  muscular  asthenia.  Gen- 
eral galvanization  answers  well  in  cases  of  sluggish  lymph- 
circulation  and  inactive  skin.  Both  currents  can  be  ad- 
ministered by  means  of  a  water-bath  which  carries  one 
pole  while  the  other  pole  is  applied  to  some  portion  of  the 
patient's  skin  (out  of  the  water).  Static  applications  are 
useful  (potential  alternation,  insulation).  Last  but  by  no 
means  least,  general  high-frequency  applications  are  ca- 


THERAPEUTIC  INDEX.  429 

pable  of  producing  splendid  effects  on  metabolism  (D'Ar- 
sonval's  cage,  diasolenic  cylinder). 

To  improve  the  tone  of  the  vegetative  functions  of  the 
organism,  vibratory  stimulation  (mild  rapid  strokes,  three 
to  five  minutes  daily)  along  the  sixth  to  the  twelfth  dorsal 
vertebrae  on  either  side  of  the  median  line  should  be  prac- 
ticed. Manual  manipulations  may  be  given  with  the  patient 
lying  on  the  right,  patient's  left  arm  raised  up,  his  hand  rest- 
ing on  left  side  of  his  head.  The  operator  should  stand 
on  the  side  of  the  table  toward  which  the  patient's  face  is 
directed,  pass  his  left  hand  over  the  patient's  shoulder,  his 
right  hand  over  lower  ribs  of  patient,  until  his  fingers  rest 
on  the  left  side  of  the  spine  between  the  sixth  and  twelfth 
dorsal  vertebrae.  AYith  his  fingers  firmly  placed  on  the  line 
described,  the  muscles  of  the  spine  should  be  drawn  upward, 
downward  and  outward  successively  by  regular  movements 
of  the  operator's  hands.  Let  the  patient  turn -over  on  his  left 
side  with  his  right  arm,  operator  facing  the  patient  for 
treatment  of  the  muscles  on  the  right  side  of  the  median 
line.  This  mode  of  manipulation  is  an  excellent  stimulant 
for  the  general  metabolic  functions  through  the  splanchnic 
nerves  and  may  be  followed  by  vibration,  as  indicated  above. 

The  therapeutic  directions  given  comprise  the  general 
treatment  of  chronic  inflammatory  or  catarrhal  states.  They 
should  be  applied,  singly  or  in  combination,  with  due  regard 
to  the  peculiarities  of  the  individual  patient.  The  object  of 
general  treatment  is  to  improve  the  system  at  large  and  in- 
cidentally remove  the  evidences  of  auto-intoxication  (reflex 
symptoms).  General  treatment  is  indicated  in  all  chronic 
catarrhal  conditions.  If  the  seat  of  the  trouble  is  directly 
accessible,  e.  g.  in  many  diseases  of  women,  the  local  treat- 
ment is  equally  important.  Since  the  local  management  of 
a  catarrhal  state  depends  upon  many  incidental  contingen- 
cies, it  is  necessary  to  discuss  the  details  thereof  separately 
under  the  head  of  special  conditions. 

Inoperable  Malignant  Disease. — The  uses  of  the 
X-ravs  and  Finsen-ra<:s  in  the  treatment  of  cancer  have 


430  MODERN  PHYSIO-THERAPY. 

been  referred  to  in  the  chapters  on  X-RAY  THERAPY  and 
PHOTO-THERAPY.  Many  cases  of  cancer,  especially  those 
who  are  suffering  from  an  inoperable  variety  of  malignant 
disease,  should  be  given  the  benefit  of  a  form  of  electro- 
therapeutic  treatment,  which  is  by  no  means  as  well  known 
and  as  extensively  employed  as  it  deserves  to  be,  to  wit: 
cataphoresis.  The  rationale  and  technique  as  well  as  the 
practical  results  achievable  are  sufficiently  well-established 
to  justify  the  classification  of  cataphoresis  as  one  of  the 
foremost  of  non-surgical  therapeutic  methods  in  the  treat- 
ment of  cancer  and  surely  in  inoperable  cases  the  most  avail- 
able. It  it  the  one  method  that  holds  out  hope  after  all  else 
has  failed  and  has  the  great  advantage  of  being  compara- 
tively a  mild  and  simple  procedure. 

Cataphoresis  by  means  of  zinc-mercury  electrodes  for 
the  destruction  of  cancer-cells  consists  in  the  diffusion 
through  the  tissues  of  nascent  salts  of  zinc  and  mercury, 
which  are  the  products  of  the  chemical  action  taking  place 
when  the  fluids  of  the  body  act  upon  the  metallic  substances 
of  the  electrode.  The  products  of  this  electrolytic  process 
invade  the  tissues  in  all  directions  from  the  point  of  appli- 
cation, combining  with  the  albumen  of  the  tissues  and  form- 
ing albuminates  of  zinc  and  mercury.  Cancer-cells  have 
but  little  resisting  power  and  rapidly  break  down.  Normal 
cell-elements,  having  a  higher  degree  of  resisting  power, 
withstand  the  action  of  these  destructive  agents.  The  range 
of  activity  of  the  latter  is  marked  during  the  first  forty- 
eight  hours  by  a  reddened  and  puffy  area,  which  G.  Bet- 
ton  Massey,  who  is  the  champion  of  this  method,  designates 
as  the  "zone  of  sterilization."  Granger  speaks  of  the  selec- 
tive and  detective  action  of  the  zinc  and  mercury  salts, 
which  seem  to  follow  up  and  ferret  out  the  proliferations 
of  the  malignant  tissue  much  more  perfectly  than  the  knife 
of  the  surgeon  or  the  Roentgen  ravs  do  or  can. 

The  technique  of  this  form  of  cataphoresis  is  simple 
and  can  be  modified  to  suit  the  indications  of  any  kind  of  a 
suitable  ca?e  and  the  varying  ideas  of  different  operators. 


THERAPEUTIC  INDEX.  431 

Short  applications  frequently  repeated  with  a  current- 
strength  of  thirty  to  fifty  milliamperes  might  be  made,  or 
the  cataphoric  destruction  may  be  accomplished  in  one  sit- 
ting with  the  patient  under  the  influence  of  an  anesthetic, 
five  hundred  and  more  milliamperes  being  employed.  The 
application  can  be  made  by  a  suitably  shaped  electrode 
which  is  placed  on  the  surface,  or  by  means  of  pointed  elec- 
trodes introduced  in  one  or  more  places  into  the  very  sub- 
stance of  the  growth.  The  tip  of  the  electrode  is  a  zinc- 
mercury  amalgam.  The  electrode  must  be  connected  posi- 
tively. The  application  is  continued  until  the  discoloration 
of  the  surrounding  tissues  indicates  that  the  local  reaction 
is  complete.  Eventually  the  diseased  tissue  will  break  down 
and  be  discharged.  The  remaining  cavity  or  ulcer  is  sup- 
posed to  be  healthy  and  heals  accordingly.  It  is  understood 
that  cleanliness  and  attention  to  surgical  details  should  not 
be  lost  sight  of.  The  method  has  been  used  in  all  kinds  of 
sarcomatous  and  carcinomatous  diseases,  especially  those 
which  were  inoperable.  In  rodent  ulcer,  indolent  ulcers, 
etc.,  the  method  has  been  employed  with  much  success. 
The  late  Dr.  Gaston,  of  Atlanta,  advocated  the  cataphoric 
introduction  of  Donovan's  solution  (liquor  hydrargyri  et 
arsenii  iodidi)  in  th*  treatment  of  malignant  growths  and 
ulcers.  The  method  was  used  in  a  case  of  inoperable  sar- 
coma of  the  abdominal  wall,  the  ultimate  outcome  of  the 
case  being  a  perfect  cure. 

Zinc-mercury  cataphoresis  has  been  used  in  cases  of 
malignant  disease  of  the  breast,  tongue,  upper  maxilla, 
glands  of  neck,  rectum,  uterus,  face,  pelvic  bones,  coccyx, 
etc. 

A  mild  form  of  metallic  cataphoresis  is  the  use  of  a  mer- 
cury-covered electrode.  It  produces  alterant  and  solvent 
effects  and  has  been  employed  successfully  in  cases  of  pelvic 
adhesions.  The  use  of  a  zinc  electrode  is  indicated  in  tuber- 
cular glands  and  in  all  conditions  requiring  a  powerful  local 
germicidal  reaction. 

The  dietetic  aspect  of  the  cancer-problem  is  of  some  in- 


432  MODERN  PHYSIO-THERAPY. 

terest.  That  the  use  of  meat  has  some  connection  with  the 
etiology  of  cancer,  seems  certain.  Cancer  cases  are  more 
frequent  in  the  United  States  than  anywhere  on  earth.  It 
is  a  well-known  fact  that  there  is  more  meat  consumed  by 
the  American  people  than  by  any  other  nation  or  race.  In 
China  cancer  is  comparatively  rare.  Among  the  (fruit- 
eating)  natives  of  the  East  Indies  cancer  is  unknown  (Dar- 
win). There  seems  to  be  no  doubt  that  the  increasing 
prevalence  of  cancer  suggests  a  physical  degeneration  of 
the  race. 

All  cancer-cases  should  be  given  the  benefit  of  invigor- 
ating general  treatment  (static  electricity  to  improve  the 
nervous  system,  dry-heat  cylinder  to  promote  excretion, 
colon-irrigation  to  improve  bowel-function). 

Insomnia. — Find  the  cause.  Symptomatic  relief  might 
be  obtained  from  positive  static  head-breeze,  galvanism 
(positive  to  head,  negative  to  spine)  galvanic  bath  (nega- 
tive in  water,  positive  to  back  of  neck),  effleurage  over  fore- 
head and  suggestion  of  sleep,  irrigation  of  colon,  hot  appli- 
cation to  abdomen,  firm  pressure  over  nape  of  neck  to  in- 
duce cerebral  anemia,  hot  foot-bath,  vibration  over  cervical 
vertebrae  and  centrifugally  along  the  arms  and  legs,  a  cold 
moist  pack  from  the  feet  to  the  neck,  a  short  hot  bath,  a 
protracted  warm  bath  or  a  general  dry-heat  treatment.  Se- 
lect the  proper  regime  in  keeping  with  the  cause  of  the 
sleeplessness. 

Intra-pelvic  Inflammations. — The  term  has  reference 
to  the  numerous  inflammatory  conditions  which  may  pre- 
vail in  the  female  pelvis,  involving  the  uterus,  the  tubes, 
the  ovaries  and  the  connective  and  peritoneal  tissue  closely 
related  to  the  intra-pelvic  organs.  We  may  encounter  acute, 
subacute  and  chronic  inflammations  of  the  uterus  (metritis), 
tubes  (salpingitis),  ovaries  (ovaritis),  of  the  connective 
tissue  around  the  uterus  (para-metritis)  or  in  the  pelvis 
at  large  (pelvic  cellulitis),  of  the  serous  covering  of  the  in- 
ternal genitalia  (peri-metritis,  pelvic  peritonitis)  in  various 
degrees  of  severity  and  due  to  a  variety  of  causes.  The  eti- 


THERAPEUTIC  INDEX.  433 

ology  of  the  inflammatory  state  should  carefully  be  con- 
sidered in  adopting  a  therapeutic  regime.  Sexual  hygiene 
should  be  enforced  in  all  these  cases,  ( i )  by  cleanliness  (vag- 
inal douches  and  warm  ablutions),  (2)  regulation  of  cohab- 
itation, and  (3)  in  certain  cases  by  attention  to  the  functions 
of  the  bladder  and  rectum  (catheterization,  rectal  injec- 
tions). 

ACUTE  INFLAMMATIONS. — Rest  is  the  first  and  most  im- 
portant therapeutic  factor.  The  general  management  does 
not  differ  from  the  regime  which  is  indicated  in  all  acute 
inflammatory  conditions.  (See  INFLAMMATION.)  Diet 
and  hydro-therapeutic  measures  are  probably  the  most  es- 
sential therapeutic  agents  in  the  treatment  of  inflammatory 
affection  in  the  female  pelvis.  The  same  holds  good  in 
regard  to  subacute  conditions,  especially  if  pain  is  a  pro- 
nounced symptom. 

CHRONIC  INFLAMMATIONS. — The  broad  features  of  treat- 
ment are  suggested  in  the  discussion  of  catarrhal  condi- 
tions generally.  (See  INFLAMMATION,CHRONIC.)  In  the 
individual  case  the  local  treatment  will  depend  on  many 
accidental  features.  There  may  be  a  low  form  of  inflam- 
mation involving  the  tissue  of  the  cervix  or  uterus  and 
associated  with  considerable  enlargement  of  the  affected 
portions  owing  to  proliferation  of  connective  tissue  (hyper- 
plasia).  The  catarrhal  surface  may  be  engorged  and  may 
bleed  easily.  It  may  be  broken  down  in  places,  giving  rise 
to  ulcers  and  granulation.  The  catarrhal  state  may  involve 
some  of  the  connective  or  peritoneal  tissue.  There  may 
be  foci  of  inflammatory  reaction  that  nature  attempted  to 
repair  in  the  presence  of  abnormal  nutritional  and  functional 
conditions,  the  result  being  the  formation  of  cicatricial  tis- 
sue. The  latter  may  have  caused  neighboring  parts  to  be 
dragged  out  of  their  normal  position,  c.  g.  the  uterus. 
Inflammatory  exudates,  instead  of  being  absorbed,  may 
continue  to  exist  in  a  more  or  less  advanced  state  of  organ- 
ization, causing  changes  in  the  relation  of  the  pelvic  con- 
tents or  giving  rise  to  pain,  disturbed  defecation  and  mic- 


434  MODERN  PHYSIO-THERAPY. 

turition,  various  disorders  by  pressure  on  special  struc- 
tures (nerves,  rectum,  bladder,  etc.).  Then  there  may  be 
the  thousand  and  one  symptoms  produced  by  reflex  irrita- 
tion of  the  nervous  system  or  by  absorption  of  toxic  ma- 
terial from  the  sluggish  venous  and  lymphatic  circulation  in 
the  pelvis.  In  all  these  conditions  the  object  of  the  treat- 
ment should  be  to  stimulate-  metabolism  in  the  affected  re- 
gion, to  tone  up  innervation,  to  restore  normal  relation  by 
breaking  up  adhesions  and  forcing  the  absorption  of  exu- 
dates.  (See  PELVIC  ADHESIONS  AND  EXUDATES.)  Many 
of  these  cases  present  purely  surgical  problems,  but  by  no 
means  as  frequently  as  the  gynecologist  of  to-day  would 
lead  us  to  believe.  Operative  treatment  in  many  of  these 
cases  is  unnecessary  and  not  infrequently  useless.  Physio- 
therapy has  established  a  conservative  system  of  gynecol- 
ogy  for  which  the  world  is  indebted  in  no  small  measure 
to  the  genius  and  resourcefulness  of  the  American  physio- 
therapeutists. 

In  order  to  stimulate  metabolism  in  the  pelvis,  and  in 
this  way  to  help  in  the  absorption  of  exudates,  extravasa- 
tions and  effusions,  depleting  applications  to  the  external 
parts  and  to  the  abdomen  are  useful.  Some  gynecologists, 
notably  G.  M.  Blech,  have  championed  the  local  use  of 
light  as  a  substitute  for  hydro-therapeutic  applications.  The 
treatment  is  given  by  means  of  a  specially  constructed  chair, 
which  is  provided  with  incandescent  lamps.  Powerful  stim- 
ulation of  skin  function  primarily  and  metabolism  second- 
arily follows  the  application,  the  effect  being  partly  due 
to  the  action  of  the  thermic  rays,  partly  to  that  of  the  lumi- 
nous rays.  A  treatment  lasting  fifteen  to  thirty  minutes 
may  be  administered  daily.  It  is  advantageously  followed 
by  a  vaginal  high-frequency  application  for  ten  minutes. 
In  this  way  the  reaction  is  intensified,  not  to  speak  of  the 
disinfectant  action  of  the  high-frequency  radiations. 

The  galvanic  current  is  adapted  to  these  cases  in  a  va- 
riety of  ways.  In  applying  it  we  must  bear  in  mind  that 


THERAPEUTIC  INDEX.  435 

the  positive  pole  attracts  oxygen  and  contracts  the  blood- 
vessels. It  temporarily  increases  local  oxidation,  but  less- 
ens the  actual  amount  of  blood  which  is  carried  to  the 
part.  In  intensifying  oxidation  it  stimulates  the  lymphatics 
and  promotes  absorption.  By  contracting  the  vessels  it 
forces  the  veins  to  evacuate  their  contents  and  regenerates 
the  quality  of  the  nutriment  which  is  carried  to  the  part.  Or- 
dinarily an  application  (five  to  twenty  milliamperes)  should 
last  from  ten  to  twenty  minutes  to  produce  these  effects.  It 
can  be  repeated  once  every  other  day.  The  negative  pole 
can  be  put  in  a  convenient  place  near  by.  The  abdominal 
wall  is  a  splendid  place  of  application  for  the  negative  pole 
by  means  of  a  flat  pad-electrode.  In  all  conditions  in  which 
it  is  desirable  to  intensify  the  change  of  tissue-elements 
locally  and  thus  to  help  in  a  physiological  regeneration  of 
the  affected  part,  the  positive  pole  should  be  used  as  the 
active  pole.  It  should  be  brought  as  close  to  the  affected 
portion  as  possible  by  means  of  a  suitable  (vaginal,  uterine) 
electrode.  The  styptic  action  of  the  positive  pole  makes  it 
ideally  available  in  treating  surfaces  that  are  congested  and 
have  a  tendency  to  bleed. 

After  pathological  changes  have  taken  place,  the  con- 
structive effect  of  the  positive  pole  must  be  supplanted  by 
the  destructive  action  of  the  negative  pole,  especially  in 
chronic  inflammatory  conditions  of  the  mucous  membranes, 
attended  by  hyperplasia,  thickening  and  hardening  of  the 
underlying  tissues.  The  dehydrating  action  of  the  negative 
pole  causes  disintegration  of  the  morbid  tissue  and  gives 
a  powerful  impetus  to  the  process  of  repair  by. the  reaction 
which  follows,  and  resembles  a  mild  type  of  an  obliterative 
inflammation.  The  positive  pole  is  placed  on  the  back  or  on 
the  abdomen,  the  negative  pole  being  applied  directly  to 
the  affected  surface  or  part  by  a  suitable  instrument.  The 
effect  can  be  enhanced  by  wrapping  moist  cotton  or  chamois 
around  the  tip  of  the  electrode.  A  current  of  from  five  to 
fifteen  milliamperes  can  be  advantageously  employed  for 
five  to  ten  minutes  every  two  or  three  days,  depending  on 


436  MODERN  PHYSIO-THERAPY. 

the  degree  of  reaction  which  is  desired  in  the  individual 
case. 

In  cases  where  a  germicidal  effect  together  with  an 
astringent  action  is  desired,  the  use  of  a  copper  electrode 
with  the  positive  pole  (cupric  electrolysis)  is  of  advantage. 
The  affinity  of  the  positive  current  for  oxygen  causes  the 
latter  to  combine  with  the  copper,  forming  an  oxide  of  cop- 
per. The  sodium  chloride  contained  in  the  blood  is  decom- 
posed, the  free  H  Cl  combining  with  the  copper  oxide,  the 
result  of  the  combination  being  oxy-chloride  of  copper, 
which  has  strongly  germicidal  and  astringent  properties. 
It  is  even  carried  into  the  deeper  tissues  by  cataphoric 
action  and  can  be  advantageously  employed  in  many  in- 
fective  (purulent)  conditions  of  the  pelvic  contents. 
Chronic  suppuration  in  the  pelvis  (c.  g.  in  one  or  both 
Fallopian  tubes)  may  follow  an  acute  infective  process. 
After  the  acute  stage  has  passed,  the  purulent  fluid  loses 
its  specific  infective  character  and  becomes  more  or  less 
innocuous.  The  pus-germs  cease  to  be  active.  In  cases 
of  this  kind  conservative  electro-therapeutic  treatment  in 
conjunction  with  other  means  to  promote  local  metabolism 
leads  to  absorption  and  excretion  of  the  fluid,  leaving  a 
healthy,  dry  cavity  behind.  In  addition  to  the  therapeutic 
measures  mentioned,  galvanization  of  the  pelvis  (one  elec- 
trode in  a  sitz-bath,  the  other  on  the  back,  poles  frequently 
reversed)  is  a  local  alterant  of  great  virtue.  A  similar 
action  can  be  produced  by  using  a  douche  as  a  conductor. 
(See  LEUCORRHEA.) 

To  restore  the  muscular  tone  of  the  pelvis,  faradization 
is  an  agent  of  unquestioned  value.  It  can  be  administered 
by  means  of  a  suitable  vaginal  or  uterine  electrode  or  by 
the  hand  of  the  operator,  who  holds  one  sponge-electrode 
in  the  unengaged  hand  while  the  other  electrode  is  placed 
on  the  patient's  abdomen  or  held  in  her  hand.  Faradization 
by  means  of  a  local  or  general  bath  is  likewise  useful. 

Additional  points  of  interest  pertaining  to  the  treatment 
of  these  chronic  diseases  of  women  are  contained  in  the 


THERAPEUTIC  INDEX.  437 


discussion  of  a  number  of  special  subjects.     (See 

TRITIS,  PERITONITIS,  PELVIC  ADHESIONS  AND  EXUDATES.) 

Jaundice  (Catarrhal).  —  The  diet  of  the  patient  should 
consist  of  carbo-hydrates  principally  (fats  and  starches  ex- 
cluded), fresh  fruit,  soups,  olive-oil  and  plenty  of  water. 
Highly  seasoned  foods,  spices,  sweet  or  sour  foods,  should 
be  avoided.  Colon  irrigation,  hot  applications  to  the  liver, 
"derivating"  packs  to  the  lower  extremities,  galvanism 
(positive  pad-electrode  over  right  hypochondrium,  nega- 
tive over  lumbar  region),  vibration  and  high-frequency  cur- 
rents over  spine  and  general  sun-baths,  are  valuable  auxil- 
iaries. The  hot  vapor-bath  or  dry-heat  cylinder  should  be 
used  once  or  twice  weekly  to  stimulate  skin-elimination. 
The  regime  outlined  is  applicable  in  all  congestive  condi- 
tions of  the  liver. 

Lateral  Sclerosis.  —  The  therapeutic  regime  does  not 
differ  from  that  which  is  resorted  to  in  cases  of  degenera- 
tion of  the  posterior  columns.  (See  LOCOMOTOR  ATAXIA.) 

Leucorrhea.  —  Catarrhal  conditions  of  the  vaginal,  cer- 
vical or  uterine  mucous  membrane  require  local  cleanliness 
(warm  douches)  daily.  Applications  of  a  high-frequency 
current  by  means  of  a  suitable  vaginal  glass-electrode  are  of 
advantage.  Local  vapor-baths  (sitting  over  a  vessel  con- 
taining very  hot  water)  or  local  exposure  to  light,  as  recom- 
mended by  G.  M.  Blech,  once  daily,  has  an  alterant  effect 
and  helps  to  correct  the  local  circulation.  To  counteract 
passive  congestion  of  the  vaginal  mucosa,  introduce  a  posi- 
tive vaginal  copper  electrode,  negative  pad-electrode  on 
abdomen,  twenty  milliamperes  for  ten  minutes  every  other 
day.  Some  wrap  a  wet  cloth  or  wet  cotton  around  the 
vaginal  electrode.  Intra-uterine  applications  are  made  in 
the  same  manner,  care  being  taken  to  loosen  the  electrode 
by  reversing  the  current.  The  use  of  an  aluminium  or 
nickel  vaginal  electrode  connected  negatively,  the  positive 
pad-electrode  on  the  abdomen  is  sometimes  advantageous. 
Duration,  dosage  and  frequency  as  above.  This  application 
is  contra-indicated,  if  parts  are  hyperesthetic.  Bennett 


438  MODERN  PHYSIO-THERAPY. 

recommends  the  so-called  hydro-electric  douches  by  means 
of  a  syringe,  the  tip  of  which  carries  a  copper  wire  and  thus 
allows  an  electric  current  to  pass  through  the  water  over 
the  affected  area.  Technique  as  before.  For  other  local 
and  general  measures  see  INFLAMMATION  (CHRONIC).  Coi- 
tion should  be  avoided,  especially  in  vaginal  leucorrhea. 
Deep  vibration  from  last  dorsal  vertebrae  down  to  coccyx, 
and  manipulation  of  the  muscles  of  the  region  named,  can 
be  added  to  the  treatment  in  cases  where  circulation  is 
sluggish. 

Liver-spots  (Chloasma). — Negative  electrolysis.  (See 
FRECKLES.) 

Locomotor  Ataxia. — The  impotence  of  drug-medica- 
tion in  the  treatment  of  the  slow  but  steady  degeneration 
of  the  posterior  columns  of  the  spinal  cord  and  of  the  pos- 
terior nerve-roots  is  admitted  on  all  sides.  On  the  other 
hand,  it  is  a  well-recognized  fact  that  the  physical  and  me- 
chanical methods  are  capable,  not  only  of  relieving  some 
of  the  disagreeable  and  distressing  concomitant  phenomena 
Lut  influencing  the  course  of  the  disease  itself.  The  clinical 
picture  presented  by  a  typical  case  of  tabes  dorsalis  is 
familiar.  The  disease  presents  three  distinct  phases.  The 
first  stage  is  marked  by  sensory  disorders.  During  the  sec- 
ond stage  co-ordination  is  impaired  and  lost.  During  the 
hist  stage  paralysis  supervenes.  Destruction  of  nerve-tis- 
sue is  complete.  Death  closes  the  scene.  The  cause  of  the 
disease  is  obscure,  although  it  is  not  unlikely  that  it  is  fre- 
quently a  late  manifestation  of  a  syphilis  acquired  by  an  an- 
cestor, not  necessarily  belonging  to  the  preceding  genera- 
tion. It  may  be  an  atavistic  appearance  of  lues  or  rather  of 
a  luetic  taint.  Syphilis  is  undoubtedly  the  predisposing 
cause,  although  the  potency  of  exciting  causes  (excessive 
venery,  sexual  perversions,  excesses  of  various  kinds,  etc.) 
must  not  be  lost  sight  of.  The  four  familiar  pathognomonic 
symptoms  of  tabes  dorsalis  are  (i)  absence  of  the  patellar 
reflex;  (2)  inability  to  remain  in  a  firm  erect  posture  with 
eyes  closed;  (3)  loss  of  pupil  reflex  to  light,  but  preserva- 


THERAPEUTIC  INDEX.  439 

tion  of  reaction  to  accommodation ;  (4)  ability  of  the  patient 
to  fully  extend  his  legs  while  lying  on  his  back  with  knees 
drawn  up. 

The  therapy  of  an  incipient  case  of  locomotor  ataxia 
should  begin  with  the  enforcement  of  an  absolutely  perfect 
hygiene,  physical  and  mental  rest,  fresh  air  and  sunlight. 
If  the  stomach  of  the  patient  is  in  good  condition,  the  pa- 
tient can  be  fed  to  a  liberal  nitrogenous  diet,  care  being 
taken  that  the  bowels  are  kept  open  and  that  the  stomach 
is  not  overtaxed.  If  the  stomach  is  in  poor  condition,  the 
course  of  the  disease  will  be  more  rapid.  The  diet  under 
these  circumstances  will  have  to  be  in  keeping  with  the 
actually  existing  conditions.  (See  DYSPEPSIA.)  It  may  be 
of  interest  to  know  that  fish  and  oysters  have  always  en- 
joyed a  great  reputation  as  parts  of  the  menu  of  tabetic 
subjects.  Alcohol  and  tobacco  must  positively  be  excluded. 
The  general  management  of  a  case  should  include  a  general 
eliminative  treatment  in  the  thermic-cylinder  or  electric- 
light  cabinet,  followed  after  an  hour's  rest  by  general  mas- 
sage. A  treatment  of  this  kind  should  always  be  given 
twice  a  week.  Its  relative  severity  should  be  adapted  to 
the  tolerance  of  the  individual  patient.  If  other  eliminative 
procedures  are  resorted  to,  the  above  general  treatment 
must  be  given  less  often  and  modified  to  suit  existing  condi- 
tions. For  the  sake  of  classification  and  convenience,  the 
available  therapeutic  methods  are  presented  under  special 
heads.  The  physician  will  have  no  difficulty  in  adapting 
therapeutic  details  to  the  requirements  of  the  individual 
case. 

MECHANO-THERAPY. — The  tendency  of  modern  thought 
seems  to  be  in  the  direction  of  carefully  regulated  exercise 
for  tabetic  subjects  from  the  hips  up  and  the  application  of 
systematic  massage  from  the  hips  down,  and,  for  that  mat- 
ter, massage  of  the  whole  body  every  day.  I  can  not  quite 
agree  with  the  idea  of  no  exercise  afoot,  as  J.  K.  Mitchell 
puts  it.  During  the  early  stages  of  the  disease,  exercise  on 
foot  is  inseparable  from  the  enjoyment  of  fresh  air,  sun- 


440  MODERN  PHYSIO-THERAPY. 

shine  and  mental  hygiene  (occupation  of  the  patient's  mind 
with  pleasant  objects).  If  exercise  is  well-regulated  and 
not  carried  to  the  point  of  fatigue,  it  can  not  but  be  pro- 
ductive of  much  benefit.  Kneipp  sought  to  deplete  the  con- 
gested medulla  by  forcible  derivation  to  the  lower  ex- 
tremities. He  made  his  tabetic  patients  walk  barefooted  in 
wet  grass  to  get  the  benefit  of  exercise,  derivation,  fresh 
air  and  mental  occupation.  Massage  is  valuable  as  an 
anodyne  for  the  relief  of  the  lightning  pains  in  the  lower  ex- 
tremities and  also  the  attacks  of  pain  in  the  region  of  the 
spine.  Centripetal  effleurage  of  the  lower  extremities  and 
deep  petrissage  over  the  spine  are  indicated. 

To  compensate  for  the  impairments  or  loss  of  muscular 
co-ordination  the  patient  should  be  taught  to  learn  certain 
movements  mechanically  and  by  constant  repetition  edu- 
cate his  muscles  to  execute  these  movements  in  obedience 
to  his  will.  Many  methods  and  systems  have  been  proposed 
for  this  purpose.  They  are  all  modifications  of  Frankel's 
movement-cure  for  tabetics.  The  patient  whose  co-ordi- 
nation is  deficient,  must  be  shown  what  movements  he  is 
supposed  to  execute.  With  the  co-operation  of  his  eyes  to 
guide  him,  he  will  make  a  faint  attempt.  The  attempt  must 
be  repeated  over  and  over  again  until  the  muscles  which 
are  concerned  in  the  movements  have  been  mechanically 
educated  to  go  through  the  motions  easily  and  safely,  even- 
without  the  guidance  of  the  eyes.  With  infinite  patience 
and  tactful  consideration  on  the  part  of  the  physician  and 
an  equal  amount  of  cheerful  co-operation  and  willingness 
on  the  part  of  the  patient  much  good  can  be  accomplished. 
To  keep  the  patient  in  a  cheerful  and  tractable  mood,  the 
exercises  or  movements  must  not  be  carried  to  the  point 
of  exhaustion  or  even  fatigue. 

The  easiest  and  least  fatiguing  movements  must  be  tried 
first.  To  relieve  the  patient  of  carrying  his  weight,  he 
should  take  his  first  exercises  in  the  dorsal  decubitus,  after- 
wards in  the  sitting  posture,  and  finally  standing  and  even 
walking.  The  first  exercises  must  be  simple,  e.  g.  extend- 


THERAPEUTIC  INDEX.  441 

ing  or  raising  a  foot  or  flexing  the  toes.  Afterward  the  ex- 
ercises can  be  more  complex,  e.  g.  combining  the  two 
movements  named.  In  very  weak  cases  it  might  be  neces- 
sary to  begin  with  passive  movements  or  to  combine  active 
and  passive  movements.  The  patient  must  be  taught  to  go 
through  the  motions  accurately,  not  merely  to  move  the 
limbs,  but  to  move  them  in  keeping  with  well-defined  and 
well-understood  directions.  After  a  certain  movement  has 
been  learned  and  can  be  performed  without  the  assistance 
of  the  sense  of  sight,  the  physician  can  institute  concentric 
or  excentric  resistance-movements  of  the  muscles  and  parts 
that  have  been  trained.  (See  chapter  on  MRCHANO 
THERAPY.)  The  movements  themselves  can  be  varied  in  an 
infinite  variety  of  ways,  c.  g.  by  bending,  straightening,  ab- 
ducting, adducting,  raising,  inverting,  everting,  rotating  a 
toe,  several  toes,  one  foot,  both  feet,  one  leg,  both  legs  in 
the  lying-down,  sitting  or  standing  position.  The  patient 
may  be  taught  to  stand,  to  balance  himself  on  one  foot,  to 
elevate  his  foot,  his  leg,  his  thigh,  to  place  his  foot  forward, 
backward  or  in  any  other  position,  to  walk  a  chalk-line  or 
to  step  from  one  given  point  to  another,  to  turn  around,  to 
step  over  obstacles,  to  sit  down  and  rise,  to  ascend  and  de- 
scend stairs,  etc.,  etc.  Little  by  little  the  patient  must  be 
trained  while  his  mind  is  kept  in  a  cheerful  frame.  It  is  by 
no  means  easy  to  superintend  a  course  of  mechanical  edu- 
cation as  outlined  above.  Much  judgment  is  necessary 
lest  the  patient  be  injured  by  too  much  exercise.  He 
usually  remains  unconscious  of  fatigue  and  is  liable  to  suffer 
irreparable  damage.  The  best  results  are  achieved  in  insti- 
tutions where  tabetics  are  taught  in  classes  under  the  direc- 
tion of  a  competent  instructor.  The  treatment  does  not  aim 
at  a  cure,  but  at  removal  of  the  most  distressing  symptom 
of  the  disease,  i.  e.  loss  "of  co-ordination.  This  form  of 
kinesi-therapy  is  applicable  in  many  allied  disorders,  prin- 
cipally in  the  treatment  of  paralytic  conditions. 

The  suspension  method,  which  has  been  championed  by 
Charcot  and  Weir  Mitchell,  is  a  form  of  local  mechano- 


442  MODERN  PHYSIO-THERAPY. 

therapy  that  deserves  to  be  better  known  and  more  exten- 
sively employed  than  it  is.  The  seances  should  be  short  and 
be  carefully  watched.  The  method  can  be  combined  with 
the  movement-cure  or  be  independently  used  for  the  relief 
of  pain  along  the  spine.  A  special  apparatus  should  be 
used.  It  resembles  the  Sayre-device  for  applying  the  plas- 
ter-jacket. 

HYDRO-  AND  T  HER  MO-THERAPY. — Kneipp's  heroic  hydro- 
therapeutic  methods  in  the  treatment  of  tabes,  which  have 
many  advocates  among  physio-therapeutists,  consist  prin- 
cipally in  the  employment  of  cold  moist  packs  to  the  ex- 
tremities and  cold  douches  to  the  back,  thighs  and  knees. 
In  patients  who  are  in  fair  general  condition  this  method 
can  be  used  with  much  benefit.  After  loss  of  co-ordination, 
vaso-motor  disturbances  usually  supervene,  which  are  a 
centra-indication  to  these  severe  applications.  In  their 
place  hot  applications  might  prove  to  be  of  value  (small 
thermic  cylinder  to  the  back).  Alternate  douches  of  hot 
and  cold  water  are  productive  of  much  good,  especially  in 
cases  that  suffer  from  pain  in  the  spinal  region.  The  gen- 
eral thermic  eliminative  treatment  previously  alluded  to  is 
of  importance  in  view  of  the  syphilitic  character  of  prac- 
tically all  cases  of  tabes. 

PHOTO-THERAPY. — The  sun-bath  in  the  treatment  of 
tabes  is  a  therapeutic  agent  of  cardinal  virtue.  The  effects 
of  sunlight  in  the  management  of  chronic  diseases  have 
been  suggested  in  the  chapter  on  PHOTO-THERAPY.  T.he 
local  use  of  ultra-violet  rays  in  cases  of  tabes  offers  an  in- 
teresting clinical  problem,  although  the  published  reports 
of  cases  in  which  this  form  of  photo-therapy  was  used  sug- 
gest the  optimism  of  the  reporters  rather  than  any  well-es- 
tablished efficacy  of  the  actinic  rays  under  the  conditions 
referred  to.  To  render  the  .parts  -bloodless  and  thus  enable 
the  rays  to  penetrate  down  to  the  degenerating  nerve-tissue, 
cataphoresis  of  adrenalin  is  resorted  to,  as  suggested  by 
H.  G.  Piffard.  The  subject  is  interesting  enough  to  justify 
further  study.  The  Minin  apparatus  is  useful  as  an  ano- 


THERAPEUTIC  INDEX.  443 

dyne  and  also  as  a  counter-irritant,  taking  the  place  of  the 
more  severe  application  of  the  actual  cautery.  Its  use  is 
painless  and  can  be  continued  for  hours. 

ELECTRO-THERAPY. — In  the  first  stages  of  the  disease 
(negative  to  back,  positive  to  feet,  ten  to  fifteen  milliam- 
peres  for  ten  to  twenty  minutes  every  day  or  two).  Dur- 
ing the  second  stage,  opposite  polarity  should  be  used.  Far- 
adization helps  to  tone  up  the  muscles.  It  can  be  applied  in 
a  warm-water  bath.  Static  sprays  or  sparks  to  the  spine 
are  serviceable  (negative  during  first  stage  of  the  disease, 
positive  in  the  second  stage  and  for  the  relief  of  pain).  The 
high-frequency  current  applied  by  means  of  a  vacuum-elec- 
trode is  excellent  and  is  only  surpassed  in  therapeutic  effi- 
cacy by  a  general  application  of  high-frequency  energy 
(D'Arsonval's  cage  or  diasolenic  cylinder).  The  general 
application  is  probably  the  best  electro-therapeutic  pro- 
cedure in  the  treatment  of  locomotor  ataxia. 

VIBRATION. — Central  vibration  in  the  treatment  of  tabes 
i?  synonymous  with  peripheral  vibration.  The  "center" 
happens  to  be  the  locus  morbi.  Pain  and  disorders  of  sen- 
sation frequently  yield  to  rapid,  gentle  vibration,  especially 
if  vibration  is  preceded  by  massage  of  the  afflicted  portion. 
That  vibration  can  influence  the  retrograde  metamorphosis 
in  the  nerve-structure,  is  hardly  likely.  For  the  relief  of 
many  concomitant  symptoms  vibration  is  useful.  Dyspepsia 
often  adds  an  element  of  additional  discomfort  and  may 
require  deep  vibration  to  stir  up  the  solar  plexus.  Consti- 
pation is  a  common  condition  in  tabetic  subjects  and  may 
have  to  receive  special  treatment.  (See  CONSTIPATION.) 
I  once  had  an  opportunity  of  seeing  Arnold  Snow  admin- 
ister rectal  vibration  to  an  ataxic  patient  in  the  second 
stage  of  the  disease.  The  patient  suffered  from  spasmodic 
attacks  of  rectal  tenesmus.  The  vibration  gave  the  patient 
much  relief. 

The  treatment  of  tabes  dorsalis  offers  a  vast  field  for 
therapeutic  research  and  reasoning.  It  is  essentially  a 
chronic  disease  with  a  kaleidoscopic  variety  of  symptoms. 


444  MODERN  PHYSIO-THERAPY. 

While  it  is  unfortunately  a  fact  that  the  disease  is  practically 
incurable,  there  can  be  no  doubt  that  a  world  of  good  can 
be  done  by  physio-therapeutic  means,  not  only  in  the  relief 
of  symptoms,  but  also  in  retarding  the  degenerative  process 
which  marks  the  pathology  of  the  disease. 

Lupus  Erythematosus. — The  treatment  of  this  stub- 
born affliction  by  X-rays  has  not  been  uniformly  successful, 
although  some  observers  speak  well  of  it.  The  Finsen- 
method  is  not  effective  unless  arc-lights  of  immense  am- 
perage are  used  on  comparatively  small  patches.  The 
portable  Finsen-lamps  (five  to  ten  amperes)  are  of  no  avail. 
Metallic  electrolysis,  as  described  under  the  head  of  LUPUS 
VULGARIS,  is  sometimes  effective.  Heat-rays  (Minin-light, 
or  sunlight  concentrated  by  means  of  a  sun-glass)  have 
been  known  to  cure  superficial  cases.  The  high-frequency 
current  applied  by  means  of  a  suitable  vacuum-electrode  is 
productive  of  good  results  in  many  instances.  Even  in 
cases  of  long  standing  the  high-frequency  current  has  been 
used  successfully.  Applications  should  be  made  every  two 
or  three  days  for  five  to  ten  minutes.  A  vapor  or  dry-heat 
bath  once  or  twice  a  week  is  indicated  in  these  cases. 

Lupus  Vulgaris. — The  treatment  of  common  lupus  by 
concentrated  chemical  solar  or  electric  arc  light  rays  (Fin- 
sen-method)  is  referred  to  in  the  chapter  on  PHOTO- 
THERAPY (Part  I  of  the  book).  The  X-ray  treatment  is 
discussed  in  the  chapter  on  X-RAY-THERAPY.  Good  results 
frequently  follow  well-applied  metallic  electrolysis  by  means 
of  a  positively  charged  copper-tip  electrode  which  has  been 
moistened  with  salt  water  and  is  slowly  moved  about. 
Negative  (sponge)  electrode  is  placed  near  by.  Green  dis- 
coloration indicates  formation  of  copper  oxy-chloride.  Ap- 
plications of  high-frequency  currents  by  means  of  a  vacuum- 
electrode  are  often  beneficial  in  the  non-ulcerative  variety 
of  lupus  vulgaris.  The  thermic  solar  rays  concentrated 
by  means  of  a  sun-glass  have  been  successfully  used  in  the 
destruction  and  cure  of  lupus.  The  method  is  somewhat  ob- 
jectionable on  account  of  the  pain  involved. 


THERAPEUTIC  INDEX.  445 

Malaria. — The  different  types  of  the  plasmodium  of 
Laveran  thrive  best  where  the  conditions  are  favorable  for 
fermentation  and  decomposition,  e.  g.  in  swampy,  marshy, 
humid  places,  where  the  temperature  is  high  and  the  air 
stale  or  even  foul.  This  description — mutatis  mutandis — 
applies  to  the  conditions  prevailing  in  the  system  of  a  pa- 
tient suffering  from  the  malarial  poison :  sluggish  circula- 
tion, sub-oxidation,  deficient  elimination.  Whether  we  be- 
lieve that  the  anopheles  is  the  carrier  of  the  plasmodium, 
makes  little  difference.  Swampy,  marshy  places  can  be 
made  healthful  by  ventilation,  air  and  sunlight.  A  malarial 
system  can  be  restored  by  stimulating  the  circulation,  pro- 
moting metabolism  and  increasing  elimination.  In  either 
case  the  plasmodium  can  not  thrive.  Active  regeneration 
of  stagnant  places  makes  it  impossible  for  the  plasmodium 
to  become  a  pathogenic  factor.  Therein  lies  at  once  the 
principle  of  prophylaxis  and  treatment  of  the  malarial  state 
in  and  out  of  the  human  body.  The  details  of  treatment 
in  all  cases  of  malaria  are:  a  carbo-hydrate  (vegetarian) 
diet,  irrigation  of  the  colon,  a  sweat-bath  every  two  or  three 
days,  as  much  sunlight  and  fresh  air  as  possible.  The  liver 
must  be  kept  active.  Sluggishness  of  the  whole  system  is 
usually  coincident  with  and  produced  by  sluggishness  in 
the  portal  circulation.  To  counteract  stagnation  of  this 
kind  give  abdominal  massage,  vibration  over  the  stomach 
and  liver  and  advise  horseback  exercise.  Keep  the  blood 
fresh,  metabolism  active,  elimination  perfect,  and  the  ma- 
larial state  in  its  many  forms  will  cease  to  exist  (malaria, 
remittent  fever,  intermittent  fever,  biliousness,  malarial 
cachexia,  typho-malarial  fever,  etc.).  For  additional  clin- 
ical information  see  FUNCTIONAL  DISORDERS,  DYSPEPSIA, 
MIGRAINE.  Immunity  against  malaria  consists  in  a  per- 
fect physiological  equilibrium  of  metabolism.  If  the  latter 
can  not  be  established  owing  to  a  wretched  condition  of  the 
system  characterized  by  but  little  regenerating  power,  the 
only  advice  to  give  such  a  patient  is  to  look  elsewhere  for 
more  healthful  surroundings. 


446  MODERN  PHYSIO-THERAPY. 

An  acute  attack  can  undoubtedly  be  broken  up  tem- 
porarily by  complete  cinchonization  of  tbe  system.  In 
many  cases  the  cure  seems  to  be  as  bad  as  tbe  disease.  The 
stomach  and  liver  are  completely  enervated  and  often  re- 
main so,  even  after  a  change  of  climate.  Thus  the  mo- 
mentary action  of  quinine  which  is  gratefully  acknowledged 
as  a  necessary  evil,  is  not  an  unalloyed  boon.  Quinine  does 
not  remove  the  malarial  state.  To  do  this,  the  physio-thera- 
peutic measures  mentioned  must  be  resorted  to. 

In  the  chapter  on  the  THERAPY  OF  LIGHT,  reference  is 
made  to  the  darkness-treatment  of  malaria.  Patients  were 
confined  for  days  in  dark  rooms.  The  conclusion  to  be 
drawn  from  the  apparently  good  results  is  not  that  the  ab- 
sence of  light  killed  the  plasmodium,  but  probably  that 
the  anopheles  had  no  access  to  the  dark  room.  The  ap- 
parent immunity  of  the  negro  is  easily  understood  when  we 
consider  that  negroes  are  accustomed  to  an  outdoor  life 
and  are  usually  free  from  disorders  of  digestion,  assimila- 
tion and  metabolism. 

The  experience  of  physio-therapeutists  living  in  malarial 
sections  has  shown  that  a  treatment  in  the  dry-heat  cylinder 
will  break  up  an  acute  attack  two  or  three  hours  after. 
While  I  have  had  bountiful  opportunities  to  verify  the  value 
of  physio-therapeutic  methods  in  chronic  malaria,  I  have 
had  no  personal  experience  with  the  acute  form  of  the  dis- 
ease. 

Melancholia. — The  management  of  a  case  of  melan- 
cholia does  not  differ  from  the  therapeutic  regime  outlined 
under  the  head  of  NEURASTHENIA.  The  essential  part  of 
the  treatment  is  to  occupy  the  patient's  mind.  Suggestion 
is  a  valuable  therapeutic  agent.  Change  of  surroundings  is 
necessary  in  all  cases.  The  most  distressing  feature  in  most 
cases  is  insomnia.  This  should  be  combated  by  cold  moist 
packs  to  deplete  the  brain,  and  general  massage  to  keep 
metabolism  active.  Galvanism  (positive  to  temples  and 
forehead,  negative  to  spine)  is  beneficial.  If  there  is  a 
special  cause  for  melancholia,  remove  it. 


THERAPEUTIC  INDEX.  447 

Meningitis. — The  therapeutic  directions  for  the  man- 
agement of  inflammatory  conditions  of  the  brain,  the  cord 
and  the  enveloping  membranes  are  practically  identical 
and  therefore,  refer  to  all  forms  and  varieties  of  pachymen- 
ingitis,  leptomeningitis,  cerebral  congestion,  cerebro-spinal 
meningitis,  myelitis,  etc.  Absolute  rest  in  bed  is  essential. 
It  is  of  advantage  to  change  the  position  of  the. patient  from 
time  to  time.  The  patient  should  not  remain  on  his  back 
constantly.  The  intestinal  canal  should  be  washed  out.  The 
bladder-function  must  be  watched.  "Derivation"  to  the 
lower  extremities  and  subsequent  depletion  of  the  upper 
parts  of  the  body  must  be  accomplished  by  hot  vapor-baths, 
cold  moist  packs,  hot  dry  packs  or  baths,  dry-heat  baths  in 
thermic  cylinder,  or  electric-light  baths.  Any  of  these  pro- 
cedures are  applicable.  The  most  effective  plan  is  to  give  a 
vapor-bath  (from  feet  to  epigastrium)  and  follow  it  with 
a  hot  moist  pack.  The  technique  of  the  application  is  in- 
dicated in  the  chapter  on  THE  THERAPEUTIC  USES  OF  HEAT 
AND  COLD  and  under  the  head  of  FEVER,  INFLAMMATION, 
PNEUMONIA  and  other  special  subjects.  When  the  stage  of 
exudation  has  begun,  the  depleting  methods  indicated  above 
riiust  be  pushed  to  the  point  of  tolerance  in  order  to  force 
absorption.  This  is  a  matter  of  the  utmost  importance. 
In  syphilitic  cases  the  prognosis  depends  on  the  firmness 
and  consistency  with  which  these  directions  are  enforced. 
For  dietetic  directions  see  DIET  IN  ACUTE  FEVERS. 

Locally  leeches,  cupping,  cold  applications  or  alternate 
applications  of  heat  and  cold  are  of  value,  but  only  as  ad- 
juncts. The  essential  features  of  treatment  are  the  details 
of  general  management  indicated  above.  The  ice-bag  on 
the  head  should  be  supplanted  by  a  head-coil.  The  gal- 
vanic current  is  serviceable  in  helping  to  deplete  the  area  of 
inflammation.  The  positive  pole  should  be  applied  to  the 
spine.  Later  on,  faradization  of  the  muscles,  especially  of 
the  extremities,  may  be  resorted  to.  Statistical  evidence 
goes  to  show  that  the  therapeutic  regime  outlined  above  not 
only  improves  the  prognostic  features  of  inflammation  of 


448  MODERN  PHYSIO-THERAPY. 

the  brain,  cord  and  meninges,  but  ameliorates  the  severity 
of  the  symptoms,  shortens  the  duration  of  the  attack  and 
counteracts  the  permanent  damage  which  the  nerve-struc- 
tures frequently  sustain  as  a  result  of  severe  inflammatory 
disturbance. 

Menorrhagia. — Therapeutic  directions  analogous  to 
those  given  under  the  head  of  METRORRHAGIA. 

Metritis. — General  regime  and  local  treatment  are  iden- 
tical with  the  therapeutic  directions  given  under  the  head  of 
ENDOMETRITIS,  with  which  metritis  is  usually  associated. 

Metrorrhagia. — Treatment  should  be  planned  and  ad- 
ministered with  due  regard  to  the  cause.  To  control  bleed- 
ing, cold  applications  should  be  made  to  the  abdomen  and 
to  the  sacral  region.  In  the  extreme  cases  very  hot  vaginal 
douches  might  be  necessary.  Forcible  massage  and  com- 
pression of  the  uterus,  both  through  the  abdominal  wall  and 
through  the  vagina,  are  often  effective.  It  can  be  combined 
with  faradic  electricity  (one  pole  in  the  uterus,  the  other 
on  the  abdomen,  or  one  pole  in  the  operator's  unengaged 
hand,  the  other  in  the  patient's  hand  while  massage  is  being 
applied).  The  use  of  a  (positive)  copper-electrode  (gal- 
vanic current)  in  the  uterus  is  useful  in  some  cases.  Pack- 
ing with  gauze-tampons  during  the  interval  between  treat- 
ments is  indicated.  Hydro-therapeutic  "derivating"  appli- 
cations are  always  proper. 

Migraine. — "Bilious  headache"  is  the  classical  type  of 
an  acute  auto-intoxication.  The  object  of  treatment  should 
be  to  eliminate  the  absorbed  toxines  and  to  prevenv.  a  re- 
accumulation  of  toxines. 

TREATMENT  OF  AN  ACUTE  ATTACK. — To  prevent  or 
abort  an  acute  attack  of  migraine,  the  patient  should  be 
given  a  thermic  treatment  in  the  dry-heat  cylinder  or  eiec- 
tric-light  cabinet.  The  colon  should  be  thoroughly  irrigated 
and  food  withheld  for  at  least  eight  hours.  Locally  the 
static  head-spray  (positive  if  face  is  flushed,  negative  if 
patient  feels  faint)  should  be  given  for  ten  to  fifteen  min- 
utes once  or  twice  during  the  attack.  Pressure  over  occiput 


THERAPEUTIC  INDEX.  449 

has  a  sedative  effect.  Galvanization  (positive  pole  on  pain- 
ful place,  negative  between  scapulae)  is  useful.  Massage 
over  the  forehead  and  temples  is  helpful.  Vibration  over 
lower  cervical  and  upper  dorsal  vertebrae  is  serviceable. 
After  the  thermic  treatment  the  patient  should  be  placed  in. 
the  high-frequency  cylinder  (cage  or  diasolenic)  for  fifteen 
minutes. 

TREATMENT  DURING  THE  INTERVAL. — Outdoor  life,  sun- 
light, a  vegetable  diet,  exclusion  of  alcohol,  tobacco,  tea 
and  coffee,  avoidance  of  excesses  and  excitement,  daily  ir- 
rigation of  the  colon,  a  reasonable  amount  of  exercise  and 
a  weekly  sweat-bath  are  indicated.  Static  spray  to  the  back 
is  useful.  Galvanization  (one.  pole  over  epigastrium,  the 
other  pole  to  spine)  is  a  valuable  adjunct.  If  the  patient  is 
plethoric  and  suffers  from  congestions,  place  positive  pole 
on  back.  If  patient  is  anemic  and  sluggish,  use  negative 
pole  on  back.  The  dietetic  peculiarities  of  the  patient  should 
be  studied  closely.  Frequently  one  special  kind  of  food  pre- 
cipitates an  attack.  If  the  patient  has  trouble  with  his  eyes, 
an  oculist  should  be  consulted. 

Milk-secretion. — To  increase  the  functional  activity  of 
the  female  breast,  .place  negative  pad-electrode  on  the 
breasts,  positive  on  the  back  and  treat  daily  for  fifteen  min- 
utes with  mild  galvanic  current.  Also  use  negative  static 
spray  locally.  Hot  applications  and  massage  are  useful. 
To  decrease  milk  secretion  use  positive  current  on  the 
breasts,  negative  on  the  back.  Technique  as  before.  Cold 
applications  and  compressions  are  useful.  In  threatening 
mastitis  use  Bier's  stasis  by  means  of  a  suction  apparatus. 
Otherwise  see  INFLAMMATION  ( ACUTE)  and  SEPSIS. 

Moles. —  (See  VASCULAR  TUMORS.) 

Nasal  Catarrh. — Acute  rhinitis  (cold  in  the  head)  re- 
quires general  treatment  similar  to  that  given  under  the 
head  of  TONSILLITIS.  A  good  sweat  in  the  thermic  cylinder 
frequently  aborts  an  attack.  (See  INFLAMMATION  ( ACUTE) 
and  FEVER.) 

The  chronic  variety  of  nasai  catarrh  is  one  of  the  most 


450  MODERN  PHYSIC-THI.KAPY. 

common  conditions  encountered  in  practice.  It  is  seldom 
cured  because  the  atmospheric  conditions  are  a  constant 
source  of  irritation  and  because  local  treatment  is  inade- 
quate. General  hygienic  regulations  must  be  enforced. 
(See  INFLAMMATION,  CHRONIC.)  Locally  the  high-fre- 
quency current  (nasal  electrode)  or  metallic  electrolysis 
(positive  copper-  or  zinc-electrode  to  the  affected  surface, 
negative  back  of  neck)  ten  milliamperes  for  five  minutes 
every  day  or  two.  Mild,  rapid  vibration  over  the  cheeks 
near  the  nose  is  beneficial.  Local  treatment  is  useless  un- 
less systemic  treatment  is  enforced.  Underlying  causes 
(syphilis,  etc.)  should  receive  attention. 

Nervous  Diseases. — The  therapy  of  degenerative  dis- 
eases of  the  cord  is  suggested  under  the  head  of  LOCOMOTOR 
ATAXIA.  For  therapeutic  information  concerning  other 
reuropathic  subjects  see  INFLAMMATION  ( ACUTE),  IN- 
FLAMMATION (CHRONIC),  PARALYSIS,  REFLEX  DISORDERS, 
FUNCTIONAL  DISORDERS,  HYSTERIA,  NEURASTHENIA,  MEL- 
ANCHOLIA, EPILEPSY,  etc. 

Neuralgia. — The  treatment  depends  on  the  cause  be- 
cause neuralgia  (nerve  pain)  is  always  a  symptom,  never  a 
disease.  Hilton's  famous  definition  of  pain  ("cry  of  a  nerve 
for  healthy  blood7')  is  a  complete  and  expressive  exposition 
of  the  nature  of  neuralgia.  The  latter  is  a  symptom  rarely 
of  neuritis,  sometimes  of  pressure  of  a  tumor,  foreign  body, 
etc.,  on  a  nerve,  not  infrequently  of  toxaemia  (syphilis,  ma- 
laria, rheumatism,  metallic  poisons,  etc.),  but  most  com- 
monly of  auto-intoxication  (absorption  of  derivatives  of 
normal  excreta  and  secreta  due  to  dyspepsia,  constipation, 
anemia  so-called  and  disorders  of  nutrition  produced  by 
grief,  worry,  mental  strain  and  other  psychic  factors).  In 
all  cases  of  stubborn  neuralgia  look  to  the  stomach  and  its 
function  (see  DYSPEPSIA). 

GENERAL  TREATMENT. — The  importance  of  increased 
elimination  can  not  be  too  often  repeated  nor  too  strongly 
emphasized.  What  has  been  stated  in  this  regard  under 
the  head  of  RHEUMATISM  holds  good  in  connection  with 


THERAPEUTIC  INDEX.  451 

neuralgia.  Elimination  is  the  alpha  and  omega  of  success- 
ful treatment.  The  dry-heat  cylinder,  the  electric-light  bath 
and  the  sun-bath  have  a  deep  therapeutic  significance  in  all 
cases  of  neuralgia.  If  the  patient  is  plethoric,  f nil-blooded 
and  of  a  nervous  temperament,  put  him  on  a  simple  vegetable 
diet.  Exclude  alcohol,  coffee,  tea  and  tobacco.  If  the  pa- 
tient is  weak  and  pale,  let  him  live  on  copious  nitrogenous 
food.  Improve  his  surroundings,  physically  and  psychically. 
Even  in  cases  of  special  neuralgia  the  general  application 
of  general  high-frequency  currents  (cage  or  diasolenic) 
should  be  included  in  the  treatment. 

LOCAL  TREATMENT. — Heat  and  manipulation  are  the 
best  and  most  effective  local  agents  in  the  treatment  of 
neuralgia.  Heat  can  be  applied  by  means  of  the  Minin  ap- 
paratus, a  small  dry-heat  cylinder  or  the  local  electric-light 
bath.  The  skin  becomes  hyperemic,  the  venous  supply  of 
the  part  is  regenerated  and  waste-products  are  absorbed  or 
excreted.  The  cry  for  healthy  blood  is  stilled.  More  in- 
tense effects  on  local  metabolism  can  be  produced  by  cold 
applications  if  they  are  properly  administered  so  as  not 
,to  fail  in  their  invariable  object  to  bring  on  a  reaction.  Cold 
douches,  thrown  against  the  part  with  considerable  force, 
were  used  by  Kneipp.  Cold  moist  packs  applied  to  a  dis- 
tant part  ("DERIVATION")  were  employed  by  Priessnitz. 
Kneipp's  famous  depleting  method  (walking  in  the  wet 
grass  or  fresh  snow)  has  cured  many  a  case  of  sciatica  and 
other  forms  of  neuralgia.  All  these  methods  and  agents, 
however,  are  incomplete  without  direct  manipulation  of 
the  affected  area. 

When  the  suffering  nerve  and  the  contiguous  territory 
should  be  manipulated,  is  an  open  question.  It  seems,  how- 
ever, as  if  local  thermic  treatments  (such  as  indicated 
above)  should  be  followed  by  an  hour  of  rest  before  manip- 
ulations are  begun.  They  are  given  in  the  form  of  pressure, 
manage,  Swedish  movements,  vibration  or  oscillation. 

Simple  pressure  usually  relieves  neuralgic  pains.  When 
the  part  admits  of  the  application  of  a  firm  compression- 


452  MODERN  PHYSIO-THERAPY. 

bandage,  the  latter  should  be  applied  and  worn  as  a  pallia- 
tive measure.  Massage  of  the  aching  nerve  is  worse  than 
useless  if  it  causes  discomfort  or  pain.  Massage  in  its 
various  forms  should  be  applied  to  the  surrounding  parts, 
not  to  the  nerve-trunk  directly.  After  the  circulation  of  the 
contiguous  territory  has  been  stimulated,  passive  move- 
ments or  in  suitable  cases  excentric  movements  can  be  em- 
ployed to  intensify  the  effect  of  massage. .  It  goes  without 
saying  that  all  massage-movements  should  be  centripetal. 

Vibration  is  useful  both  centrally  and  peripherally.  Vi- 
bration of  the  affected  nerve  or  plexus  should  never  cause 
discomfort  or  pain.  The  technique  is.  correctly  given  by 
Arnold  Snow,  who  advises  interrupted  vibration  with  a 
fairly  slow  rate  of  speed.  "It  should  be  applied  lightly  at 
first ;  but,  with  increasing  tolerance,  be  intensified,  the  dim- 
inution of  pain  being  a  guide  as  to  the  increase  of  pres- 
sure. If  after  a  reasonable  effort  the  pain  does  not  cease 
or  markedly  lessen,  vibration  should  not  be  persisted  in. 
Treatments  should  be  given  daily.  In  obstinate  cases  it 
may  be  best  to  treat  twice  daily."  Powerful  vibration  of 
the  surrounding  parts  is  always  proper  and  adds  in  no  small 
measure  to  the  sum-total  of  benefit  which  the  patient  derives 
from  vibration.  The  effect  of  vibration  is  undoubtedly  due 
to  intensified  molecular  motion,  followed  by  an  increase  in 
animal-heat,  oxidation  and  accelerated  metabolism.  It 
stands  to  reason  that  the  applicability  of  the  directions  given 
depends  to  a  large  degree  on  the  anatomical  location  of 
the  nerve  treated.  The  same  holds  good  in  regard  to  oscil- 
lation. 

Central  vibration  for  the  relief  of  neuralgia  has  fre- 
quently yielded  very  good  results.  The  vibration-table 
given  under  the  head  of  PARALYSIS  will  be  found  service- 
able in  locating  the  spinal  segments  corresponding  to  cer- 
tain anatomical  regions  of  the  body.  There  is  no  doubt 
whatever  that  the  effects  of  central  vibration  are  primarily  in 
the  general  improvement  of  the  nutrition  of  a  (peripheral) 
part  and  secondarily  in  the  benefit  which  accrues  to  an  in- 


THERAPEUTIC  INDEX.  453 

dividual  structure  through  improved  nutrition  of  the  re- 
gion of  which  it  is  a  component  part.  Thus,  for  obvious 
reason,  vibration  over  the  lower  dorsal  and  the  upper  lum- 
bar vertebrae  would  be  indicated  in  cases'  of  sciatica.  The 
idea  expressed  by  M.  T.  Pilgrim  that  instrumental  vibration 
increases  the  natural  vibration  in  a  nerve  and  in  this  way 
produces  physiological  effects,  is  hardly  tenable.  Natural 
vibration  in  a  herve  is  its  medium  of  carrying  and  trans- 
mitting impulses.  Pain,  considered  in  connection  with 
nerve-physiology,  is  composed  of  accentuated  sensory  im- 
pulses. To  increase  the  natural  vibration  of  a  nerve  means 
to  magnify  the  sensory  impulses  which  it  carries.  Beyond  a 
certain  point  of  accentuation  of  sensory  impressions  the  sub- 
jective condition  is  called  "pain."  This  is  a  pathologic  state. 
11  'instrumental  vibration  relieves  pain,  it  either  does  so  by 
obtunding  the  natural  nerve-vibration  or  by  increasing  the 
natural  nutriment  of  a  nerve,  thus  enabling  the  latter  to 
carry  intensified  sensory  impressions  without  subjectively 
perceiving  them  as  "pain." 

The  therapeutic  suggestions  given  apply  in  all  cases  of 
so-called  neuralgia.  The  stomach  and  the  skin  must  re- 
ceive the  lion's  share  of  attention  at  the  hands  of  the  cli- 
nician. For  the  sake  of  completeness  the  more  common 
forms  of  neuralgia  are  added  with  suitable  suggestions: 

••  Tie-DouLouREux  (NEURALGIA  OP  THE  FIFTH  NERVE). — 
"Derivating"  baths  or  packs.  Cold  douches  to  lower  ex- 
tremities. Walking  in  wet  grass  or  fresh  snow.  Sun-bath 
locally.  Galvanism  (mild  current,  positive  pole  moved  over 
forehead,  negative  to  back  of  neck).  Positive  galvanic 
current  to  aching  points  directly,  negative  to  back  of  neck. 
Static  spray  (large  or  small)  positive  to  head,  negative  to 
platform.  Gentle  stroking  to  painful  spots.  Locally  dry 
heat.  Cataphoresis  of  cocaine,  chloroform  or  aconite  is 
bad  practice. 

ODONTALGIA.— Sometimes  a  problem  for  a  dental  sur- 
geon; Otherwise  treatment  does  not  differ  from  that  of 
tiodouloureux. 


454  .VHI>I-:K\    I'IIYSJO-TIIKKAPY. 

CEPHALALGIA. — Xot  a  true  neuralgia.  Usually  con- 
gestive headache  or  due  to  auto-intoxication  from  stom- 
ach and  intestines.  Derivation  as  in  the  treatment  of  tic- 
douloureux.  Positive  static  spray.  Pressure  over  occipital 
region.  Massage  of  forehead  and  temples.  Vibrate  over 
cervical  vertebrae.  Sometimes  an  ophthalmologic  problem. 

INTERCOSTAL  NEURALGIA. — Dry  heat.  Galvanism,  posi- 
tive pole  over  painful  spots.  Derivation  as  before.  Strap- 
ping the  affected  side  is  useful. 

GASTRALGIA. — Heat  externally  by  hot  applications,  in- 
ternally by  hot  drinks.  Positive  galvanic  pole  in  epigas- 
trium, negative  on  the  back.  Static  spray  (positive)  or 
wave-current  to  epigastrium.  Hot  sitz-baths.  Liquid  food. 

OVARIAN  NEURALGIA. — Hot  sitz-baths.  Galvanism 
(positive  pole  directly  over  aching  spot  or  in  the  vagina, 
negative  in  lumbar  region).  Static  spray  (positive)  to  ab- 
domen. Priessnitz  pack  to  abdomen.  Hot  vaginal  injec- 
tions. Pressure  over  ovarian  region. 

LUMBAR  NEURALGIA. — Rheumatic  in  character.  (See 
RHEUMATISM,  MUSCULAR.) 

SCIATICA. — Pressure,  compression-bandage,  massage 
and  vibration.  Dry  heat.  Rest  limb  in  elevated  position. 
Galvanism  as  before.  Static  spray  (positive)  locally.  Local 
sun-baths. 

The  local  treatment  of  any  neuralgia  must  always  be 
secondary  to  the  general  treatment  of  the  system.  Local 
treatment  is  desirable,  general  treatment  is  necessary.  Even 
in  old,  obdurate  cases  good  results  can  be  achieved  if  the 
physician  will  persist  in  handling  his  patient  generally  and 
locally  according  to  the  directions  and  suggestions  given 
above. 

Neurasthenia. — Nervousness  in  the  widest  and,  there- 
fore, in  a  constantly  varying  sense  of  the  word  is  supposed 
to  be  a  functional  disorder  of  the  nervous  system.  It  is  al- 
ways a  symptom  and  may  be  due  to  any  number  of  causes. 
Hartholow's  definition  is  probably  as  good  as  any:  "Mor- 
bid mental  condition  produced  by  exaggerated  suscepti- 


THERAPEUTIC  INDEX.  455 

bility  to  physical  impressions."  In  looking  for  the  cause 
of  the  affliction,  give  the  stomach  a  large  share  of  your  at- 
tention. The  symptomatology  of  the  affliction  is  infinite. 
Neurasthenia  is  found  in  conjunction  with  most  chronic 
diseases. 

In  attempting  to  handle  a '  case  of  neurasthenia  the 
physician  should  provide  for  his  patient  the  best  of  hy- 
gienic surroundings.  The  four  emunctories  should  be  kept 
active,  especially  the  bowels  and  the  skin.  Sunlight  is  in- 
dispensable. Occupy  the  mind  of  your  patient  pleasantly. 
This  might  be  accomplished  by  a  change  of  surroundings, 
travel,  relief  from  business  and  other  obligations  and  by 
suitable  companionship.  General  massage,  followed  by  a 
lukewarm  rub-down  and  an  hour's  rest,  is  very  serviceable 
in  the  neurasthenia  of  women.  Exercise  in  the  open  air 
proportionate  to  a  patient's  tolerance,  swimming,  horseback 
riding,  outdoor  sports,  etc. 

If  the  neurasthenic  state  is  the  result  of,  or  is  associated 
with,  some  chronic  ailment,  treatment  should  be  directed 
to  the  cause.  The  patient's  sexual  life  often  furnishes  the 
clew  to  the  situation.  The  mental  state  of  the  patient  is 
frequently  a  problem  which  can  only  be  solved  by  one  who 
is  familiar  with  the  patient's  family  history  and  with  the 
details  of  the  patient's  private  life.  These  should  be  taken 
into  consideration  and  should  be  made  the  means  of  reach- 
ing the  patient's  mind  and  nervous  system  by  suggestive 
influences.  In  a  few  instances  the  rest-cure  as  advocated 
by  S.  Weir  Mitchell  will  be  found  serviceable.  In  many 
cases,  however,  absolute  rest  and  isolation  mean  aggravation 
of  the  neurasthenic  state. 

The  application  of  the  high-frequency  current  to  the 
spine  by  means  of  a  vacuum-electrode  or  a  general  high- 
frequency  treatment  in  the  diasolenic  cylinder  or  D'Ar- 
sonval's  cage  is  a  powerful  therapeutic  agent  in  cases  of 
neurasthenia,  especially  if  the  patient  is  an  ill-nourished, 
anemic  subject.  Galvanization  or  faradization  of  the  spine 
is  useful  in  many  instances.  Vibration  in  carefully  selected 


456  MODERN  PHYSIO-THERAPY. 

cases  is  very  beneficial.  In  the  form  of  neurasthenia  which 
is  associated  with  nervous  dyspepsia,  vibration  over  the 
dorsal,  epigastric  and  both  hypogastric  regions  is  very  ef- 
fective. If  the  patient  is  a  malarial,  rheumatic  or  syphilitic 
subject,  general  eliminative  treatment  is  necessary.  The 
diet  of  a  patient  should  be  adapted  to  his  general  condition 
and  to  the  tolerance  of  the  stomach.  Usually  a  moderate 
nitrogenous  diet,  excluding  fats,  pastry,  spices,  coffee,  tea 
and  alcohol,  is  adapted  to  these  cases.  Tobacco  should  not 
be  allowed.  Most  cases  do  better  if  they  are  treated  away 
from  home.  Many  times  it  is  possible  to  act  upon  the  pa- 
tient's nervous  system  and  mind  through  the  special  senses. 
(See  chapter  on  PERSONAL  HYGIENE.) 

Night-sweats  are  produced  by  auto-intoxication  and 
resulting  vaso-motor  disturbances  in  the  skin.  Patients 
who  are  handled  according  to  the  regime  outlined  under 
the  head  of  TUBERCULOSIS  PULMONUM  do  not  usually  suf- 
fer from  night-sweats.  It  is  only  patients  who  are  housed 
up,  improperly  fed  and  treated  without  regard  to  the  more 
or  less  hygienic  character  of  the  surroundings,  that  sweat 
at  night  (Brehmer).  A  positive  static  insulation  toward 
evening  followed  by  a  lukewarm  sponge-bath  usually  breaks 
up  night-sweats.  Treatment  should  be  given  every  evening. 

Obesity. — Oertel's  treatment  of  obesity  consists  in  sys- 
tematic dehydration  of  the  system  (see  VALVULAR  DIS- 
EASES OF  THE  HEART)  and  augmented  oxidation  (mountain- 
climbing  to  expand  the  thorax  and  augment  the  amount  of 
oxygen).  He  emphasizes  the  necessity  of  counterbalancing 
the  physiological  effects  of  these  methods  by  a  suitable  diet 
(albumen  in  excess,  carbo-hydrates  in  moderate  quantity, 
fats  and  starches  excluded). 

If  the  reduction  of  fat  is  done  at  the  expense  of  the 
digestive  function,  it  is  harmful.  The  drinking  of  vinegar, 
the  eating  of  soap,  the  use  of  cathartics  are  objectionable 
for  the  reason  indicated.  The  treatment  of  obesity  is  diffi- 
cult because  cases  must  be  properly  individualized  and  on 
account  of  the  co-existence  of  other  diseased  conditions.  In 


THERAPEUTIC  INDEX.  457 

rheumatic  and  gouty  cases  of  obesity  the  diet  should  consist 
of  garden  vegetables  well  cooked  and  cut  crosswise  to  the 
fiber  (carrots,  parsnips,  turnips,  spinach,  lettuce,  onions, 
celery,  cauliflower,  cabbage,  beets,  string  beans).  In  addi- 
tion to  these,  fresh-water  fish,  wheat  gluten,  white  of  egg 
and  skimmed  milk.  Keep  bowels  open.  If  there  is-  no 
rheumatism  or  gout,  lean  beef,  mutton  or  chicken  might  be 
allowed  and  milk  excluded.  Starches  and  fats  (all  fried 
foods)  should  be  forbidden.  Coffee,  tea  or  alcohol  can  be 
allowed  in  very  small  quantities,  water  as  little  as  possible. 
If  the  heart  is  good,  the  dry-heat  cylinder  or  general  elec- 
tric-light bath  can  be  employed  every  three  or  four  days. 
Chest-exercise,  mountain-climbing,  general  massage  and 
Swedish  movements,  fresh  air  and  sunlight  should  be  added 
to  the  dietetic  regime.  (See  chapter  on  DIETETICS.  See 
RHEUMATISM.) 

Occupation-neuroses. — This  term  refers  to  a  number  of 
conditions  characterized  by  painful  cramping,  weakness  or 
extreme  sensitiveness  and  irritability  of  certain  muscles  as 
the  result  of  overexertion  of  these  muscles.  The  most 
familiar  form  of  an  occupation-neurosis  is  writer's  cramp. 
Other  types  are  observed  in  the  hands  and  wrists  of  piano- 
players  and  violinists,  in  the  calves  of  dancers,  in  the  lips  of 
cornetists,  all  of  whom  constantly  use  certain  muscles  until 
muscular  tone  is  exhausted.  The  therapy  consists  in  rest, 
massage,  mild  faradization  or  galvanism  of  the  afflicted 
muscles.  Vibration  along  the  course  of  the  principal  nerve- 
trunks  of  the  part,  also  central  vibration  as  indicated  in 
the  vibration-table  under  the  head  of  PARALYSIS.  In  treat- 
ing the  wrist,  a  dry-heat  treatment  in  a  small  thermic  cylin- 
der or  local  electric-light  bath,  followed  by  a  high-frequency 
treatment  of  the  whole  arm,  is  useful.  Massage  of  the 
muscles  near  the  afflicted  part  helps  to  tone  up  the  mus- 
cular structure  of  the  whole  member  and  incidentally 
strengthens  the  afflicted  arm.  Treatment  should  be  given 
every  day  or  two.  Later  on,  Swedish  movements  of  the 
affected  region  can  be  added. 


458  MODERN  PHYSIO-THERAPY. 

Opsonic  Therapy. — No  scientific  achievement  of  recent 
years  has  made  such  a  deep  impression  on  the  medical  mind 
as  the  remarkable  biologic  work  that  has  given  us  the 
knowledge  of  those  elements  which  in  their  totality  repre- 
sent the  self-sustaining  force  of  the  organism  (i'is  medi- 
catrix  naturae).  These  researches,  in  their  ultimate  con- 
clusions, are  so  closely  allied  with  the  philosophic  basis  of 
physio-therapy  that  intelligent  discussion  of  the  latter  now- 
adays would  hardly  be  possible  without  due  consideration 
of  the  additional  scientific  evidence  which  these  researches 
furnish  on  behalf  of  strictly  physiological  methods  of 
therapy. 

The  pioneer  work  in  this  important  department  of  biol- 
ogy was  done  by  MetschnikorT,  who  studied  the  role  which 
the  white  corpuscles  of  the  blood  play  in  the  protection  of 
the  animal  body  against  germs  of  disease  and  their  destruc- 
tive activity.  Metschnikoff  showed  that  the  white  cor- 
puscles in  reality  are  the  protectors  and  defensors  of  the 
body  in  as  much  as  they  actually  wage  war  against  the 
intruding  germs  of  disease,  attack  and  destroy  them.  He 
called  them  phagocytes  (eating  cells),  because  they  devour 
the  invading  bacteria.  The  process  itself  he  called  phago- 
cytosis. This  subject  was  taken  up,  studied,  and  elaborated 
by  many  observers,  who  elicited  many  new  and  interesting 
details.  It  was  found  that  the  fighting  quality  or  eating 
capacity  of  the  blood-cells  is  variable  and  dependent  on 
many  circumstances.  The  so-called  phagocytes  do  not  at 
all  times  possess  the  same  degree  of  power  to  cope  with 
pathogenic  intruders.  Sometimes  their  power  is  very  slight, 
under  other  circumstances  it  is  very  considerable.  If  this 
power  is  so  great  that  germs  of  disease  can  enter  the  body 
without  being  able  to  do  harm,  the  body,  as  a  result,  is 
practically  proof  against  their  activity.  This  condition  is 
called  immunity.  It  represents  the  highest  phagocytic 
power  of  the  blood-cells. 

Leishman,  Wright,  Douglass,  Bulloch,  and  others  have 
studied  the  subject  of  phagocytosis  from  many  points  of 


THERAPEUTIC  INDEX.  459 

view.  It  was  elicited  that  the  fluids  of  the  blood  themselves 
possess  certain  properties  that  affect  the  phagocytic  action 
of  the  blood-cells.  Wright  used  for  his  earliest  experi- 
ments the  cultures  of  one  of  the  pus-producing  gerrns,  the 
staphylococcus  pyoyenes  aureits.  He  attributed  the  pecu- 
liar effects  observed  to  the  action  of  certain  elements  con- 
tained in  the  blood  fluids.  These  elements  modify  the  bac- 
teria, weaken  them  and  in  this  way  render  them  a  ready 
prey  to  the  phagocytes.  Since  the  bacteria  are  devoured 
by  the  phagocytes,  the  action  of  the  elements  in  the  blood- 
fluids  is  similar  to  the  function  of  the  cook  who  prepares 
the  food  for  eating.  In  this  case  the  bacteria  are  the  food. 
The  cook  is  represented  by  the  elements  in  the  blood-fluids 
which  modify  the  bacteria  or  render  the  food  eatable. 
These  elements  in  the  blood-fluids  were  for  this  reason 
called  opsones  or  opsonins.  The  Greek  word  opson  means 
a  "side-dish."  The  verb  opsonco  means  "to  provide  food" 
or  "to  prepare  food."  Thus  the  meaning  of  the  word  opso- 
nin  becomes  plain.  The  conclusion  which  Wright  and 
Douglass  drew  from  their  early  experiments  were  mainly : 

1.  The  opsonic  power  is  possessed  both  by  the  serum 
And  by  the  plasma  of  the  blood. 

2.  When  serum  is  heated  to  60°  C.  it  loses  its  opsonic 
action.     It  becomes  "devitalized"  or  "inactivated"  serum. 

3.  Inactivated  serum  has  the  same  influence  on  phago- 
cytosis as  physiological  salt  solution. 

4.  If  blood-fluids  are  allowed  to  stand,  they  gradually 
lose  their  opsonic  power  (about  50  per  cent,  in  five  or  six 
days). 

Ross  in  a  splendid  monograph  on  the  subject,  summar- 
ized the  subject  as  follows : 

"1.  Opsonins  act  by  chemically  uniting  with  the  invad- 
ing bacteria,  and  so  altering  them  that  the  leucocytes  are 
able  to  phagocyte  the  bacteria  and  destroy  them.  It  is  im- 
portant to  remember  that  these  substances  do  not  stimu- 
late or  otherwise  affect  the  leucocytes. 


460  MODERN  PHYSIO-THERAPY. 

"2.  It  is  probable  that  there  are  present  many  varieties 
of  opsonins  in  the  blood  plasma,  each  one  having  to  do 
with  combating  a  particular  kind  of  microbic  invasion. 

"Opsonins  have  been  shown  to  be  distinct  from  other 
bacteriotropic  substances,  such  as  bacteriolysins,  the  agglu- 
tinins  and  antitoxins." 

The  comparative  estimation  of  a  patient's  power  of 
resistance  to  an  invasion  of  a  given  germ  is  called  the  "op- 
sonic  index"  of  the  patient.  To  find  the  opsonic  index  of 
a  patient  for  any  given  microbe,  the  serum  to  be  tested  is 
mixed  with  fresh  human  leucocytes  and  the  mixture  ob- 
served in  its  action  upon  the  particular  bacterium  under 
investigation.  The  method  is  well  described  by  Ohlmacher, 
who  states  that  by  the  ingenious  methods  of  Wright  and 
his  associates,  Leishman  and  Douglass,  it  is  possible  to 
study  experimentally,  outside  of  the  living  body,  the  action 
of  the  blood  serum  called  opsonic.  If  one  takes  fresh  blood 
of  man  or  any  other  common  mammal  and  washes  the 
corpuscles  free  from  serum,  the  polymorphonuclear  leuco- 
cytes will  not  ingest  such  pathogenic  bacteria  as  the  pyo- 
genic  cocci,  color!  bacilli,  or  tubercle  bacilli  when  these  are 
mixed  in  the  form  of  a  fluid  suspension  with  the  washed 
corpuscles  and  incubated  fifteen  to  thirty  minutes.  If, 
however,  to  this  mixture  of  washed  corpuscles  and  bac- 
teria blood  serum  be  added,  the  phagocytic  leucocytes  at 
once  begin  to  take  up  the  bacteria,  and,  in  proportion  to 
the  opsonic  power  of  that  particular  serum  against  that 
particular  kind  of  bacterial  parasite,  the  number  of  bac- 
teria engulfed  by  a  given  number  of  leucocytes  in  a  certain 
period  of  incubation  will  vary.  In  virtue  of  its  opsonin, 
which  sensitizes  the  bacteria  so  as  to  allow  the  white  blood 
cells  to  take  them  up  by  phagocytosis,  the  blood  serum  pro- 
duces the  effect  just  described.  Against  a  given  pathogenic 
microbe,  as,  for  example,  the  staphylococcus  aureus,  the 
serum  of  one  individual  tested  by  a  refinement  of  the 
method  just  outlined  will  permit  the  leucocytes  to  take  up 
an  average  number  of  the  cocci,  the  number  representing 


THERAPEUTIC  INDEX.  .  461 

this  individual  phagocytic  index  for  staphylococcus.  The 
relation  which  exists  between  the  phagocytic  index  of  one 
individual  and  that  of  others,  presumably  normal,  constitutes 
the  so-called  opsonic  index.  This  opsonic  index  assumes 
practical  importance  because  it  seems  to  bear  a  definite  re- 
lation to  an  individual's  resistance  against  a  given  disease- 
producing  microbe.  With  subacute  and  chronic  infections 
the  opsonic  index  is  usually  low  for  the  corresponding  bac- 
terial species. 

Wright  has  shown  that  by  artificial  bacterial  autoinocu- 
lation  one  may  increase  resistance  against  the  correspond- 
ing organism  to  a  point  at  which  healing  of  infectious 
processes  occurs.  The  bare  fact  that  immunity  could  be 
induced  or  heightened  by  the  use  of  pathogenic  bacteria  or 
their  products  has  been  established  and  extended  from  the 
day  of  Pasteur's  epoch-making  studies  in  the  bacteriology 
of  infectious  diseases;  and  from  Buchner's  day  it  was 
shown  that  the  blood  serum  bore  an  important  part  in  the 
body's  combat  against  micro-parasites ;  while  the  role  of 
the  living  body  cell  was  demonstrated  by  the  brilliant 
Metschnikoff.  But  figuratively  it  remained  for  Wright  to 
so  modify  the  vaccine  of  Pasteur  as  to  arouse  in  the  serum; 
of  Buchner  a  substance  which  prepared  the  disease-pro- 
ducing microbe  for  destruction  by  the  phagocyte  of  Metsch- 
nikoff; thus  bringing  to  practical  humanitarian  usefulness 
the  laboriously  studied  theories  of  three  pioneers  in  bio- 
logic therapy  (Ohlmacher). 

The  diseased  conditions  in  which  the  method  of  Wright 
is  applicable  may  be  classified  bacteriologically  thus : 

1.  Conditions  due  to  entrance  of  the  staphylococcus  py- 
ogenes  (acne,  furuncle,  sycosis  and  many  similar  skin  dis- 
eases) ; 

2.  Conditions  produced  by  the  bacillus  coli  communis 
(cystitis,  fistulous  afflictions,  etc.)  ; 

3.  Gonococcus  invasions  (acute  and  chronic  gonorrhea, 
gonorrheal  rheumatism,  gleet,  etc.)  ; 


462  MODERN  PHYSIO-THERAPY. 

4.  Lotalizecl  or  general  conditions  caused  by  the  bacil- 
lus tuberculosis. 

The  chief  and  only  object  in  the  treatment  is  to  raise  the 
opsonic  index.  A  patient  with  a  localized  infection  will 
have,  as  a  rule,  a  constantly  low  index,  while  one  suffering 
from  a  general  infection  will  have  a  fluctuating  index — at 
one  tirrte  high  above  normal,  and  at  another  time  below 
normal.  Auto-inoculation  takes  place  in  the  latter  case, 
while  it  does  not  in  the  former,  and  it  is  obvious  from  these 
two  statements  why  infections  of  a  general  nature  are  not 
appreciably  benefited  by  this  treatment. 

Wright's  method  is  limited  to  bacterial  infections  and 
is  most  favorable  in  those  cases  having  a  low  opsonic  index. 
For  the  sake  of  illustrating  the  plan,  let  us  assume  that  we 
have  to  treat  a  case  of  pustular  acne.  The  first  thing  to  do 
is  to  examine  the  pus  to  determine  the  organism  present. 
Next  find  the  patient's  opsonic  index.  If  it  is  low,  vaccine 
inoculations  should  be  made.  A  vaccine  as  it  is  understood 
here  is  a  standardized,  sterile  emulsion  of  the  organisms 
found  in  the  pus  of  the  lesion.  Under  aseptic  precautions 
inject  into  the  patient  a  vaccine  of  two  hundred  and  fifty 
million  cocci.  When  this  is  done  it  becomes  very  interest- 
ing to  watch  and  observe  what  takes  place  in  the  patient. 
Immediately  following  the  injection  there  is  a  fall  of  the 
opsonic  index,  but  a  reaction  soon  takes  place  and  the  index 
begins  to  rise,  and  within  four  to  six  days  the  index  will 
reach  normal  and  go. above  it,  remaining  stationary  for  a 
few  days  and  begin  to  fall  again.  The  curve  will  graphi- 
cally represent  the  exact  conditions.  The  falling  index  is 
called  the  "negative  phase,"  the  increasing  index  is  called 
the  "positive  phase,"  the  stationary  condition  is  called  the 
"high  tide."  The  patient's  blood  is  kept  under  examination, 
and  when  the  second  "negative  phase"  appears  and  the 
index  is  returning  to  normal,  another  inoculation  with  vac- 
cine should  be  made.  The  index  continues  to  fall  after  the 
second  injection  is  given,  but  reaction  soon  follows  and 
the  index  shoots  up  again,  probably  higher  than  before, 


THERAPEUTIC  INDEX.  463 

remains  stationary  and  begins  to  fall.  In. such  cases  an 
inoculation  should  be  made  about  every  ten  days,  but  in 
all  cases  they  should  be  controlled  entirely  by  the  index. 
After  a  few  inoculations,  as  a  rule,  marked  improvement 
will  be  observed  in  the  patient  (King). 

Wright's  fundamental  rules  for  therapeutic  applications 
in  cases  of  bacterial  infections  are: 

1.  Isolate  in  pure  culture  the  causative  micro-organism. 

2.  Estimate  the  opsonic  power  of  the  patient's  blood  to 
this  micro-organism. 

3.  If  the  opsonic  index  be  at  or  below  normal,  prepare 
and  standardize  a  vaccine   from  this  micro-organism. 

4.  Inoculate  the  patient  with  this  vaccine  with  appro- 
priate doses  and  at  proper  intervals,  as  shown  by  a  syste- 
matic  estimation   of   the   opsonic   content   of   the   patient's 
blood. 

What  the  influence  of  Wright's  attractive  and  ingenious 
theory  will  be  on  the  therapy  of  bacterial  diseases,  it  is,  as 
yet,  too  early  to  tell.  No  one  questions  the  tremendous  im- 
portance of  Wright's  biologic  researches,  equalled  only  by 
the  brilliancy  of  MetschnikofF s  original  investigations.  To 
the  physio-therapeutist  who,  by  virtue  of  his  work,  takes 
a  biologic  view  of  disease  and,  amid  the  confusing  multi- 
tude of  therapeutic  methods  and  agents  has  never  lost  sight 
of  the  supreme  position  occupied  by  the  vis  medicatrix 
naturae,  the  opsonic  theory  of  Wright  naturally  appeals 
with  more  than  ordinary  force.  In  the  light  of  Wright's 
researches  the  i'is  mcdicatri.v  naturae  ceases  to  be  a  theoret- 
ical abstraction  or  a  convenient  generalization.  It  becomes 
a  physical  entity  accessible  alike  to  the  chemist,  the  path- 
ologist and  bacteriologist.  Strangely  enough,  the  brilliant 
work  of  two  such  master-minds  as  Metschnikoff  and 
Wright  bears  out  the  truth  of  a  statement  of  a  humble 
layman,  who  more  than  sixty  years  ago  said  that  all  con- 
tagious diseases  contain  in  their  contagion  the  materials 
necessary  for  their  cure.  That  humble  layman  was  Vin- 
cens  Priessnitz.  the  crude  father  of  modern  hydro-therapy. 


464  MODERN  PHYSIO-THERAPY. 

Orchitis. — General  therapeutic  principles  under  IN- 
FLAMMATION (AcuTE).  Ice-applications  are  of  doubtful 
propriety.  In  the  chronic  forms  of  the  disease  the  Alinin 
light  is  of  value.  Galvanism  (testicle  between  the  two 
sponge-electrodes)  is  useful.  Bennett  recommends  im- 
mersing scrotum  in  a  cup  of  water,  using  the  water  as  one 
of  the  conductors.  In  acute  orchitis  put  positive  wire  into 
the  water,  negative  to  feet.  Galvanism,  ten  milliamperes, 
ten  to  fifteen  minutes.  In  the  chronic  form  reverse  polarity 
and  use  for  five  or  ten  minutes.  Massage  of  the  enlarged 
testicle  is  beneficial. 

Pain. — Find  the  cause.  Symptomatic  relief  may  be  had 
from  the  judicious  employment  of  pressure  (in  accessible 
passive  congestions,  some  forms  of  neuralgia),  massage 
(muscular  rheumatism,  passive  congestions),  heat  (in  most 
inflammatory  conditions),  cold  (in  some  inflammatory 
states,  suppuration),  Minin  light,  X-rays,  high-frequency 
currents,  positive  pole  of  galvanic  and  static  currents,  vibra- 
tion, sun-bath,  various  kinds  of  hydro-therapeutic  applica- 
tions and — last  but  not  least — suggestion.  (See  FUNC- 
TIONAL DISORDERS,  REFLEX  DISORDERS,  RHEUMATISM,  etc.) 
Pain  is  never  a  pathological  condition,  but  always  a  guide- 
post  to  some  seat  of  disturbance.  The  proper  treatment 
always  depends  on  the  cause. 

Palpitation  of  the  Heart. — A  cold  application  to  the 
precordium  usually  has  a  sedative  effect.  Other  means  of 
relieving  an  acute  attack  are :  positive  static  insulation, 
deep  vibration  over  upper  dorsal  vertebrae,  galvanization 
(negative  side  of  neck,  positive  precordium),  lukewarm 
bath,  hot  pack  to  lower  extremities.  Try  to  find  the  cause 
and  remove  it.  (See  DYSPEPSIA,  FUNCTIONAL  DISORDERS, 
REFLEX  DISORDERS.) 

Paralysis. — Impairment,  perversion  or  loss  of  motion, 
inasmuch  as  it  is  a  peripheral  effect,  is  only  a  symptom  and 
must  be  dealt  with,  with  due  regard  to  the  cause  primarily 
concerned  in  the  production  of  the  paralytic  state.  The 
cause  may  be  disease  of  nerve-tissue,  inflammation  of 


THERAPEUTIC  INDEX.  465 

nerve-sheaths,  hemorrhage  and  subsequent  pressure  of  a 
blood-clot,  tumors,  etc.,  etc.  It  may  be  a  hemiplegia,  if  it 
involves  a  lateral  half  of  the  body ;  a  paraplegia,  if  it  in- 
volves the  body  from  the  waist  down ;  a  monoplegia,  if  it 
involves  a  single  member.  Not  all  paralyses  are  effects  of 
structural  lesions.  Hysterical  paralyses  are  not  infrequent. 
Sometimes  paralyses  are  evidences  of  auto-intoxication  and 
disappear  when  the  cause  ceases  to  act.  Some  forms  of 
paralysis  are  toxemic  in  character  (e.  g.  the  post-diphthe- 
ritic variety).  At  times  paralysis  appears  as  the  symptom  of 
a  gradually  supervening  or  progressive  deterioration  of  the 
nervous  system.  On  general  principles  we  may  consider 
the  curability  of  the  paralytic  state  in  direct  proportion  to 
the  tractability  of  the  underlying  condition.  In  keeping 
with  the  anatomical  site  of  the  lesion  paralyses  are  said  to 
be  of  encephalic,  spinal  or  peripheral  origin. 

GENERAL  TREATMENT. — If  a  paralytic  condition  is  due 
to  auto-intoxication,  toxemia,  or  some  systemic  (blood) 
disease,  it  is  of  vital  importance  to  correct  the  hygienic  sur- 
roundings, to  adapt  the  dietetic  habits  to  existing  conditions 
and  to  regenerate  the  nutritional  state  by  promoting  and 
correcting  metabolism.  Stimulate  oxidation  by  fresh  air 
and  sunlight.  Feed  the  patient  on  an  excess  of  tissue-con- 
sumers (vegetable  diet),  unless  there  is  a  slow  and  gradual 
loss  of  weight  which  would  have  to  be  met  by  a  supporting 
nitrogenous  diet.  Keep  the  kidneys  active  by  liberal  potions 
of  fresh  water.  Irrigate  the  colon  every  day  or  two.  The 
general  electric-light  bath  or  the  dry-heat  body-cylinder 
should  be  used  every  three  or  four  days.  General  massage, 
static  insulation,  the  galvanic  or  faradic  water-bath,  the 
wave-current  to  the  spine,  the  body-diasolenic  or  auto-con- 
densation couch  may  be  added  for  their  powerful  .tonic 
effects. 

LOCAL  TREATMENT. — Among  the  various  therapeutic 
agents  that  are  used  to  restore  the  functional  power  of  mus- 
cles, the  most  available  one  is  undoubtedly  massage.  The 
afflicted  parts  should  be  manipulated  by  effleurage,  petris- 


466  MODERN  PHYSIO-TIIF.KAPY. 

sage,  friction,  tapotement,  successively  and  conjointly. 
Thermic  stimuli  (local  electric-light  bath,  Minin  light,  hot 
applications,  alternate  hot  and  cold  douches)  are  useful  to 
improve  local  nutrition.  The  electric  (faradic  or  galvanic) 
water-bath  can  be  employed  if  an  arm  or  a  leg  is  to  be 
treated.  Vibration  over  the  affected  region  is  a  valuable 
adjunct.  Static  sprays  and  in  suitable  cases  sparks  may 
be  given  locally.  The  electric  massage-roller  answers 
nicely  in  some  cases. 

Central  stimulation  by  manipulation  and  vibration  of 
the  spine  is  of  importance  hi  the  treatment  of  paralytic  cases. 
The  following  list  of  control-stations  may  serve  as  a  guide 
in  the  manipulation  and  vibration  of  the  different  portions 
of  the  spine : 

Segment  of  the  cord  corresponding  to  the  location  of 
the  first  cervical  vertebra;  controls  motion  of  the  following 
muscles:  recti  laterales,  rectus  capitis,  anticus,  posticus, 
sterno-hyoid,  sterno-thyroid. 

Second  and  third  cervical:  sterno-mastoid,  trapezius, 
scaleni,  omohyoid,  diaphragm. 

Fourth  cervical:  diaphragm,  deltoid,  biceps,  coraco- 
brachialis,  supinator  longus,  rhomboid,  supra-spinatus,  in- 
fra-spinatus. 

Fifth  cervical:  deltoid,  biceps,  brachialis  anticus,  long 
I'.ncl  short  supinator,  deep  scapular  muscles,  rhomboid,  clavic- 
ular portion  of  pectoral  muscles. 

Si.rth  cervical:  deltoid,  biceps,  brachialis  anticus,  sub- 
scapular,  pectoralis,  serratus  magnus,  triceps,  pronatores, 
latissimus  dorsi. 

Seventh  cervical:  triceps,  extensores,  pronatores,  flex- 
ores,  subscapular  pectoralis,  latissimus  dorsi. 

Eighth  cervical:  triceps,  flexores  digitorum. 

First  dorsal:  extensores  pollicis,  musculi  manuum  in- 
terni,  musculi  thenares  et  hypothenares. 

Second  to  twelfth  dorsal:  muscles  of  back,  abdominal 
muscles,  and  spinal  erectors. 

First  lumbar:  none. 

Second  lumbar:  vastus  internus. 


THERAPEUTIC  INDEX.  467 

Third  and  fourth  lumbar:  sartorius,  adductors,  abduct- 
ors, flexores  and  extensors  of  thigh. 

Fifth  lumbar:  flexors  of  knee,  flexors  of  ankle,  peronei, 
extensors  of  toes. 

First  and  second  sacral:  muscles  of  calf,  glutseal  mus- 
cles, peronei,  extensors  of  ankle,  small  muscles  of  the  foot. 

Third,  fourth  and  fifth  sacral:  muscles  of  the  rectum, 
bladder  and  genital  organs. 

Paralysis  may  be  associated  with  loss,  perversion  or  im- 
pairment of  sensation  (anesthesia,  loss  of  sensation;  pares- 
thesia,  perverted  sensation;  hyperesthesia,  increased  sensi- 
bility). Manipulation  and  vibration  of  the  spine  is  capable 
of  influencing  thsse  conditions.  The  following  list  may 
serve  as  a  guide : 

Second  and  third  cervical:  occipital  region  and  back  of 
neck. 

Fourth  cervical:  neck,  front  of  shoulder  and  outer  por- 
tions of  arm. 

Fifth  cervical:  back  of  shoulder,  outer  portion  of  arm 
to  the  wrist. 

Sixth  cervical:  outer  portion,  front  of  forearm  and  back 
of  hand. 

Seventh  cervical:  radial  side  of  hand,  palm,  index  and 
one-half  of  middle  finger. 

Eighth  cervical:  ulnar  portion  of  hand,  dorsum  of  hand 
and  inner  portion  of  forearm. 

First  dorsal:  inner  side  of  forearm  and  arm. 

Second  dorsal:  inner  side  of  arm  near  and  in  axilla. 

Second  to  twelfth  dorsal:  chest,  abdomen,  upper  glutasal 
region. 

First  lumbar:  groin  and  front  of  scrotum. 

Second  lumbar:  lumbar  region,  outer  and  upper  portion 
of  thigh. 

Third  lumbar:  front  and  outer  side  of  thigh. 

Fourth  lumbar:  inner  side  of  thigh,  leg  and  foot. 

Fifth  lumbar:  back  of  thigh,  outer  portion  of  leg  and 
ankle,  sole  and  dorsum  of  foot. 


468  MODERN  PHYSIO-THERAPY. 

First  and  second  sacral:  back  of  buttock  and  thigh,  side 
of  leg  and  ankle,  sole  and  dorsum  of  foot. 

Third,  fourth  and  fifth  sacral:  anus,  rectum,  penis,  ure- 
thra, vagina  and  perineum. 

Knowledge  of  these  anatomical  points  enables  the  phy- 
sician to  make  direct  application  of  any  suitable  therapeutic 
agent  to  the  spinal  centers  for  the  purpose  of  influencing 
peripheral  manifestations.  The  osteopaths  aim  to  loosen 
the  muscular  structure  of  special  parts  of  the  back  and  cor- 
rect the  relative  position  of  the  vertebrae  by  manipulation 
and  by  Swedish  movements.  The  application  of  vibration 
is  based  on  the  same  principle,  although,  as  far  as  thera- 
peutic efficacy  is  concerned,  it  is  not  equal  to  the  osteopathic 
method  of  manipulation,  the  claim  of  some  anxious  vibrator- 
makers  notwithstanding.  It  is  always  wise  to  combine  vi- 
bration of  the  spine  with  vigorous  massage  of  the  muscles 
of  the  back  and  with  Swedish  movements  to  engage  certain 
muscles  and  in  this  way  force  motion  of  the  individual  ver- 
tebrae in  relation  to  the  contiguous  vertebra.  The  same 
principles,  in  a  somewhat  varied  sense,  apply  to  hydro- 
therapeutic  procedures  (douches  and  packs  of  the  back). 
The  direction  in  which  electrical  force  travels  can  not  be 
perfectly  controlled  when  applications  of  a  galvanic,  faradic, 
static  or  high-frequency  current  to  the  spine  are  made.  In 
cases  of  paralysis  and  loss  of  sensation  the  static  spark  ap- 
plied directly  to  the  spinal  region  is  probably  the  most  direct 
and  most  effective  mode  of  application.  Its  action  may  be 
peripherally  supplemented  by  sparks  or  faradic  shocks  ap- 
plied to  the  affected  muscle  or  muscles.  For  this  purpose 
the  rheotome  in  connection  with  a  faradic  current  is  very 
serviceable.  The  wave-current  applied  to  a  paralyzed  mus- 
cle by  means  of  one  or  more  pieces  of  block-tin  is  very  use- 
ful. The  region  treated  will,  by  its  anatomical  location  and 
peculiarities,  to  some  extent  determine  the  exact  manner 
of  electro-therapeutic  application  and  technique.  To  in- 
crease the  nutrition  and  metabolism  in  any  affected  region 
local  applications  of  a  mild  galvanic  current  or  a.  static  spray 


THERAPEUTIC  INDEX.  469 

or  a  high-frequency  current  may  be  added.  For  faradic  and 
galvanic  applications  one  pole  should  be  placed  over  the 
point  of  insertion  (or  origin)  and  the  other  over  the  belly 
of  the  muscle.  Electrodes  carrying  galvanic  currents 
should  be  shifted  about.  The  average  duration  of  an  elec- 
trical treatment  in  these  cases  is  fifteen  minutes,  to  be  re- 
peated every  day.  Sparking  should  not  be  done  for  more 
than  five  or  ten  minutes.  Unnecessary  irritation  of  the  skin 
must  be  avoided. 

CUNICAL  SUGGESTIONS. — In  treating  a  case  of  paralysis 
the  physician  should  never  forget  that  he  is  dealing  with  a 
symptom  and  not  with  a  disease  per  se.  He  should  never 
lag  in  his  efforts  to  find  the  cause.  This,  of  course,  is  not 
always  possible.  General  eliminative  treatment  by  means 
of  the  dry-heat  cylinder,  the  general  cold  moist  pack,  the 
electric-light  bath,  will  benefit  the  majority  of  these  cases, 
especially  those  that  suffer  from  some  form  of  intoxication. 
The  stomach  of  the  patient  should  receive  painstaking  at- 
tention. (See  DYSPEPSIA.)  The  patient  should  not  be  al- 
lowed to  suffer  from  constipation.  The  skin  must  be  kept 
active.  In  this  way  the  absorption  of  a  clot  is  promoted, 
ill-nourished  nerves  and  nerve-centers  are  stimulated  struc- 
turally and  functionally  and  toxines  of  all  kinds  (disinte- 
gration-products of  normal  secreta  and  excreta,  ptomaines, 
derivatives  of  germ-cultures  as  in  post-diphtheritic  paraly- 
sis, lead  in  plumbism)  are  eliminated.  There  is  no  doubt 
that  even  in  cases  of  paralysis  produced  by  psychic  causes 
the  actual  etiology  of  the  paralytic  state  is  an  auto-intoxica- 
tion due  to  disturbed  nerve-function  and  a  retention  of  de- 
rivatives of  normal  secretions  and  excretions.  The  physio- 
logical equilibrium  of  metabolism  is  disturbed,  auto-intoxi- 
cation is  the  result,  with  neuroses  of  divers  kinds  as  the  ex- 
ternal evidences  of  poisoned  nerves  and  nerve-centers.  If 
our  neurologists,  most  of  whom  are  satisfied  to  treat  their 
patients  symptomatically  and  cover  up  a  dearth  of  diag- 
nostic exactness  with  a  formidable  mass  of  neurological  and 
neuropathic  termini  technici,  would  only  learn  to  return  to 


470  MODERN  PHYSIO-THERAPY. 

the  simplicity  of  physiological  facts  and  name  causes  and 
not  concomitant  or  consequential  phenomena !  There  was 
once  an  old  maid  in  Cincinnati  who  developed  paralysis 
and  was  pronounced  hopelessly  afflicted  by  a  number  of 
prominent  physicians,  among  them  three  nerve-specialists. 
She  went  from  bad  to  worse  until  an  empiric  outside  of  the 
profession  took  hold  of  her  case,  treated  her  with  massage, 
a  vapor-bath  cabinet  and  a  rectal  syringe  and  cured  her  in 
less  than  three  months.  The  therapeutic  suggestions  given 
hold  good  in  all  cases  of  paralysis,  especially  those  that  are 
of  recent  origin  and  are  not  produced  by  a  trauma.  In 
cases  of  long  standing  structural  changes,  especially  the 
proliferation  of  connective  tissue  and  the  consequent 
atrophy  or  degeneration  of  the  neurons,  have  taken  place, 
the  prognosis  is  accordingly  unfavorable  (c.  g.  in  advanced 
cases  of  locomotor  ataxia).  Hysterical  paralyses  are  ac- 
cessible to  suggestive  influences  in  not  a  few  instances.  If 
the  paralysis  is  due  to  a  trauma  or  pressure  of  a  tumor, 
foreign  body,  abscess,  etc.,  the  case  offers  a  distinctly  surg- 
ical problem  with  a  prognosis  proportionate  to  the  tracta- 
bility  of  the  cause  and  the  extent  of  the  structural  damage 
already  done.  In  making  a  diagnosis  the  actual  existence  of 
paralysis  must  be  determined.  Incomplete  paralysis  (or 
paresis,  to  use  a  term  frequently  employed )  may  be  in  real- 
ity a  weakness  of  muscular  tissue  and  may  be  due  to  some 
local  trouble,  e.  g.  disease  of  a  neighboring  joint. 

The  adaptation  of  the  therapeutic  suggestions  for  the 
general  and  local  treatment  of  paralysis  will  necessarily  de- 
pend upon  the  etiology  of  the  affliction,  the  seat  of  the  lesion 
and  the  varying  features  of  the  clinical  picture  which  the 
individual  case  presents.  By  way  of  recapitulation  and 
specialization  the  following  therapeutic  summary  is  of- 
fered for  practical  guidance : 

HYSTERICAL  PARALYSIS.— Hygienic  measures.  Sugges- 
tion. Regulation  of  sex-function.  General  massage.  Far- 
adization of  spine.  Faradic  bath.  Faradization  of  affected 
part.  Isolation  of  patient  and  forced  feeding  are  recom- 
mended bv  S.  Weir  Mitchell.  Everv  form  of  static  elec- 


THERAPEUTIC  INDEX.  471 

tricity  can  be  employed.  In  many  cases  the  stomach  is  at 
fault.  (See  DYSPEPSIA.)  Frequently  it  is  possible  to  affect 
hysterical  subjects  favorably  through  the  special  senses. 
(See  chapter  on  PERSONAL  HYGIENE.)  The  influence  of 
music  on  patients  of  this  class  has  often  been  demonstrated. 

INFANTILE  PARALYSIS. — Hygienic  measures.  General 
depletent  baths  or  packs.  "Derivating"  hydro-therapeutic 
applications.  Local  massage  and  faradism  are  very  useful. 
General  high-frequency  applications. 

DIPHTHERITIC  PARALYSIS. — Elimination  through  the 
skin.  Diasolenic  cylinder.  Faradic  or  galvanic  bath.  Lo- 
cally faradism  and  massage. 

BULBAR  PARALYSIS. — Liberal  diet,  food  being  introduced 
per  rectum  or  by  means  of  a  stomach-tube.  Massage,  es- 
pecially to  affected  parts.  Galvanism  to  muscles  of  neck 
and  floor  of  mouth.  Cold  douches  and  static  sparks  to  back 
and  affected  portion.  In  some  cases  of  hyperesthesia  the 
hot  douches  and  a  mild  galvanic  current  to  the  spine  are  bet- 
ter borne.  Static  spray  to  neck  and  lower  portion  of  face. 
Mild  vibration  to  back  of  neck. 

ATROPHIC  PARALYSIS  (PROGRESSIVE  MUSCULAR  ATRO- 
PHY).— General  high-frequency  treatments,  faradic  and  gal- 
vanic baths  alternately  given.  General  massage.  Locally 
rest,  galvanism  or  faradism,  massage  and  hot  applications. 
Dry  heat  cylinder  in  syphilis  and  other  underlying  systemic 
conditions.  Sun-baths. 

FACIAL  PARALYSIS  (BELL'S  PALSY). — Open  bowels.  Dry 
heat  or  electric-light  bath.  Fresh  air.  Sun-baths.  "Der- 
ivating" hydro-therapeutic  applications.  Locally  massage, 
galvanism  and  faradism.  Cupping  in  front  of  ear.  Static 
spray.  High-frequency  current  to  affected  region. 

PARALYSIS  AGITANS. — Hygienic  measures.  Eliminative 
measures.  Nourishing  diet.  Static  insulation.  High-fre- 
quency currents.  Locally  faradic  or  galvanic  applications 
(bath  or  otherwise),  high-frequency  currents,  massage, 
vapor-baths  to  affected  parts.  Vibration,  alternate  hot  and 
cold  douches  to  spine. 


472  MODERN  PHYSIO-THERAPY. 

GENERAL  PARALYSIS  OF  THE  INSANE. — The  general  di- 
rections given  above  apply  with  supreme  emphasis  in  this 
most  peculiar  and  most  unfortunate  condition.  The  treat- 
ment should  aim  to  promote  the  constructive  metamorphosis 
of  the  organism.  (Hughes.) 

The  proper  therapeutic  indications  for  all  other  forms 
of  paralysis  and  pseudo-paralysis  (paresis)  can  without 
much  difficulty  be  deduced  from  the  previous  considera- 
tions and  suggestions.  In  some  cases  of  paralysis  the 
movement  cure  of  Frankel  can  be  employed  with  success. 
(See  LOCOMOTOR  ATAXIA.) 

Papilloma. —  (See  VASCULAR  TUMORS.) 

Pelvic  Adhesions  and  Exudates. — Many  chronic  dis- 
eases of  women  consist  of,  are  associated  with  and  are  ag- 
gravated by  the  presence  of  adhesions  and  inflammatory 
exudates.  The  latter  are  the  etiological  factors  in  not  a 
few  cases  of  versions  and  flexions  of  the  uterus. 

Adhesions  should  be  broken  up  by  intra-pelvic  massage 
as  suggested  by  Thure  Brandt.  Reference  to  this  subject 
has  been  made  in  the  chapter  on  MECHANO-THERAPY. 
Faradization  (one  pole  in  the  cul-de-sac,  the  other  on  the 
abdomen)  frequently  enhances  the  effect,  especially  in  old 
cases.  If  pain  and  a  subacute  catarrhal  condition  super- 
vene, massage  is  usually  contra-indicated.  In  these  cases 
hydro-therapeutic  applications  should  be  made  to  force  de- 
pletion and  absorption.  A  suitable  electrode  (positive)  in 
the  cul-de-sac  (negative  pad  on  abdomen)  should  be  used 
every  other  day,  galvanism  twenty  milliamperes  for  five 
minutes.  The  seat  of  the  trouble  should,  if  possible,  be 
brought  between  the  two  poles.  The  application  can  often 
be  made  on  the  abdomen  (positive)  and  on  the  back  (nega- 
tive). The  older  the  case,  the  safer  and  less  discomfort- 
ing it  is  to  use  the  negative  pole  in  the  vagina  as  close  to  the 
affected  region  as  possible.  If  the  symptoms  are  acute,  the 
positive  pole  should  be  used  in  the  vagina,  or,  better  still, 
the  electro-therapeutic  treatment  should  be  desisted  from. 
Cases  of  old  pelvic  adhesions  have  been  cured  by  means  of 


THERAPEUTIC  INDEX.  473 

mercuric  cataphoresis.  (For  additional  information  con- 
cerning the  latter  see  INOPERABLE  MALIGNANT  DISEASE.) 
The  applications  in  these  cases  are  made  by  means  of  mer- 
cury-covered electrodes  placed  in  firm  contact  with  a  sur- 
face close  to  the  adhesion  to  be  broken  up.  Faradization 
and  massage  are  valuable  adjuncts.  The  same  holds  good 
in  regard  to  exudates.  If  they  are  old  and  can  be  handled 
without  giving  rise  to  pain,  intra-pelvic  massage  should  be 
given  to  start  a  reaction.  Electro-therapeutic  indications 
as  before.  In  many  cases  the  intra-vaginal  use  of  the  high- 
frequency  current  is  of  advantage  in  helping  to  regulate  the 
circulation  and  promote  absorption.  Massage  is  practiced 
by  one  or  two  fingers  in  the  cul-de-sac  as  close  to  the  seat 
of  trouble  as  possible,  the  other  hand  of  the  operator  being 
used  on  the  abdomen  to  steady  and  immobilize  the  affected 
region.  If  the  exudate  can  be  plainly  felt  through  the  ab- 
dominal wall,  massage  and  galvanization  are  easily  admin- 
istered. Vibration  locally  is  of  advantage  if  the  exudate  is 
accessible  through  the  abdominal  wall  or  the  vagina.  Ad- 
ditional therapeutic  directions  are  given  under  the  head  of 
INFLAMMATION  (CHRONIC). 

Pericarditis. — The  regime  in  all  inflammatory  affections 
of  the  heart  (pericarditis,  myocarditis,  endocarditis,  peri- 
cardial  effusions)  is  practically  the  same.  Mental  and 
physical  rest  are  of  the  utmost  importance.  Leeches  or  cup- 
ping are  of  advantage  in  the  early  stages  of  the  disease. 
Locally  cold  applications  by  means  of  a  water-coil  are  serv- 
iceable. They  should  not  be  ice-cold.  Heat  is  usually  not 
well  borne.  Cold  moist  packs  to  the  lower  extremities  and 
other  hydro-therapeutic  measures  to  stimulate  skin-func- 
tion and  elimination  are  to  be  depended  upon  to  sustain  the 
heart  and  to  absorb  effusions.  The  general  principles  are 
discussed  under  the  head  of  PNEUMONIA.  The  bowels 
should  be  kept  open  and  the  patient  fed  on  milk  and  other 
concentrated  food-drinks  as  suggested  in  the  treatment  of 
acute  gastritis.  Other  therapeutic  suggestions  are  given 
under  the  head  of  INFLAMMATION  (  ACUTE)  and  FEVER. 


474  MODERN  PHYSIO-THERAPY. 

Peritonitis. — The  acute  form  is  usually  secondary  to 
some  other  condition  (trauma,  sepsis,  perforation  of  intes- 
tines, inflammation  in  contiguous  territory,  etc.)  and  de- 
pends, therefore,  for  its  treatment  on  the  management  and 
removal  of  the  cause.  Considered  independently  of  any 
causative  or  associated  condition,  its  treatment,  as  far  as 
the  general  features  are  concerned,  is  conducted  according 
to  the  principles  which  should  prevail  in  all  inflammatory 
and  febrile  conditions.  (See  INFLAMMATION  and  FEVER.) 
Rest  is  imperative.  If  the  bowels  are  intact,  they  should  be 
freely  and  frequently  evacuated  by  enemata.  An  abdom- 
inal compress  (Priessnitz  pack,  local  vapor-bath)  has  a 
depletent  effect  and  is  a  very  useful  local  anodyne.  In 
many  instances  the  question  of  treatment  may  be  altogether 
a  surgical  problem  from  the  beginning. 

The  chronic  form  of  peritonitis  requires  rest,  depletion 
by  hydro-therapeutic  derivation  and  many  other  therapeutic 
measures  indicated  under  the  head  of  INFLAMMATION 
(CHRONIC).  In  the  tubercular  variety  X-ray  treatment 
(moderately  hard  tube,  fifteen  to  twenty  inches  above  ab- 
dominal wall,  five  to  ten  minutes  every  two  or  three  days) 
has  been  recommended  by  some.  High-frequency  applica- 
tions over  the  abdominal  wall  are  sometimes  beneficial,  like- 
wise local  galvanization  (two  flat  electrodes,  positive  on  ab- 
domen, negative  on  the  back,  weak  current  for  five  minutes 
every  day).  The  value  of  fresh  air  and  the  actinic  rays  is 
shown  by  the  wonderful  improvement  which  at  times  fol- 
lows mere  opening  of  the  abdomen,  enabling  air  and  light  to 
enter.  Vibration,  massage,  and  all  other  violent  forms  of 
manipulation  are  contra-indicated  locally,  but  might  be  ad- 
vantageously employed  in  contiguous  territory  (legs,  back) 
to  stimulate  absorption. 

Pharyngitis. — (See  TONSILLITIS.) 

Piffard  Rays  are  produced  by  a  spark-gap  lamp  devised 
by  Henry  G.  Piffard,  of  New  York.  They  are  different 
from  the  ultra-violet  rays,  do  not  affect  the  silver  in  pho- 
tographic plates,  but  cause  a  quick  and  decided  reaction  on 
exposed  skin.  Little  is  known  about  these  rays.  They  have 


THERAPEUTIC  INDEX.  475 

been  used  with  apparent  benefit  in  cases  of  lupus  erythema- 
tosus. 

Pleurisy. — The  regime  is  similar  to  that  outlined  under 
the  head  of  PNEUMONIA.  Cupping  or  venesection  are  of 
benefit.  Strapping  the  affected  side  by  means  of  adhesive 
plaster  is  indicated  as  an  anodyne.  Absorption  of  effusions 
is  best  accomplished  by  powerful  stimulation  of  the  skin- 
function  (general  cold  moist  pack,  thermic  cylinder,  general 
vapor-bath,  as  described  under  the  head  of  FEVER,  electric- 
light  bath,  Alinin  apparatus).  For  general  therapeutic  di- 
rections see  INFLAMMATION  (  ACUTE)  and  FEVER. 

Pneumonia  (Lobar). — Acute  inflammation  of  the  lungs 
is  classified  among  the  infectious  diseases  produced  by  a 
bacterial  cause.  The  specific  micro-organism  which  is  sup- 
posed to  be  the  etiological  factor  in  the  disease  is  the  diplo- 
coccus  of  Frankel,  although  the  pneumococcus  of  Fried- 
lander,  the  typhoid  bacillus,  the  various  pus-germs  and  a 
number  of  other  micro-organisms  are  credited  with  being 
capable  of  producing  the  disease.  The  vast  difference  of 
opinion  makes  the  specific  etiology  of  pneumonia  very 
doubtful.  There  are  not  a  few  clinicians  who  look  upon 
the  bacterial  element  as  being  purely  incidental  to  the  in- 
flammatory process.  It  is  thought  that  the  germs  are  pres- 
ent everywhere  and  at  all  times,  but  that  they  never  develop 
and  multiply  until  inflamed  lung-tissue  furnishes  a  favorable 
culture  soil.  Inoculation-experiments  make  the  bacterial 
cause  of  pneumonia  appear  very  doubtful.  That  atmos- 
pheric conditions,  draughts,  exposure  to  cold,  sudden 
changes  in  the  temperature  are  predisposing,  if  not  pro- 
ductive causes,  is  admitted  on  all  sides.  That  it  may  occur 
as  a  complication  in  .the  course  of  typhoid  fever  (typho- 
pneumonia),  rheumatism,  gout,  diabetes  and  chronic  disease 
of  the  kidneys,  there  is  no  doubt.  Pneumonia  attacks  by 
preference  young,  vigorous  males.  Alcoholism,  tobacco- 
habit  and  addiction  to  an  exclusive  meat-diet  make  the 
prognosis  very  grave,  because  of  the  loss  of  resisting  power 
on  the  part  of  the  nervous  system  and  the  heart. 


476  MODERN  PHYSIO-THERAPY. 

Croupous  pneumonia  (acute  inflammation  of  the  lungs) 
is  the  classical  type  of  a  self-limited  disease.  In  an  indi- 
vidual having  ordinary  good  health,  the  disease,  if  left  alone, 
and  the  ordinary  hygienic  regime  being  enforced,  ought  to 
run  its  course  and  terminate  in  recovery.  There  is  no  acute 
disease  which  is  more  interfered  with  by  meddlesome  drug- 
therapy  to  the  detriment  of  the  patient,  than  pneumonia. 
The  drugging  usually  begins  at  the  outstart  when  aconite 
and  veratrum,  strychnine  and  alcohol  are  called  into  requi- 
sition. In  years  gone  by,  venesection  was  practiced  during 
the  first  stage  of  pneumonia.  It  has  become  obsolete,  al- 
though its  rationale  as  an  antiphlogistic  is  unquestioned 
and  a  good  deal  more  logical  than  the  action  of  the  various 
medicinal  agents  which  have  supplanted  it.  The  loes  of 
blood  incidental  to  venesection  has  a  tendency  to  lessen 
the  patient's  resisting  power.  Venesection  without  loss  of 
blood  would  be  the  ideal  antiphlogistic  method.  This  is 
what  hydro-therapy  has  given  us  in  the  various  modes  of 
water-application  which  are  known  as  "derivating"'  meth- 
ods. "Derivation"  (depletion  of  the  congested  area)  is 
the  alpha  and  omega  of  treatment  during  the  first  stage  of 
the  disease  in  every  case.  It  has  a  tendency  to  abort  or 
jugulate  the  disease  or,  failing  in  this,  to  render  the  course 
of  the  disease  comparatively  mild. 

The  onset  of  pneumonia  is  usually  announced  by  a  tem- 
pestuous reaction  on  the  part  of  the  system  (chill,  convul- 
sions, severe  vomiting),  followed  by  a  rapid  rise  in  the 
temperature.  Embarrassment  of  the  pulmonary  circulation 
is  marked  by  a  rapid  but  full  pulse,  quick  breathing,  short 
inspiration  and  long  expiration  accompanied  by  a  moan, 
anxious  facial  expression,  pain  near  the  nipple,  intense  pros- 
tration, etc.  The  picture  is  too  characteristic  to  be  mis- 
taken. The  treatment  in  this  condition  (I  am  almost 
tempted  to  call  it  specific  treatment)  hinges  upon  the  appli- 
cation of  the  cold  moist  pack  from  the  feet  to  the  costal 
border.  The  technique  of  this  most  useful  hydro-therapeu- 
tic application  is  clearly  set  forth  in  the  first  part  of  this 


THERAPEUTIC  INDEX.  477 

book  under  the  head  of  HYDRO-THERAPY.  The  congested 
area  must  be  depleted  by  drawing  the  bulk  of  the  blood  to 
the  lower  portions  of  the  body.  This  is  venesection  with- 
out loss  of  blood.  The  pack  should  last  an  hour  and  be  re- 
peated two  or  three  times  daily.  It  should  be  applied  with- 
out disturbing  the  patient.  In  some  cases  it  is  of  advantage 
to  make  a  cold  application  to  the  chest  while  the  first  pack  is 
being  applied.  An  ice-cap  to  the  head  is  useful,  especially 
where  head-  and  brain-symptoms  are  present. 

The  air  in  the  sick-room  should  be  fresh  and  pure,  not 
too  cold  and  not  too  dry.  The  room  should  be  well-venti- 
lated, the  patient  being  protected  against  draught.  If  the 
room  is  cold,  a  grate-fire  can  be  kept  up.  The  temperature 
should  not  exceed  70°  F.  If  the  air  is  too  dry,  a  little  water 
in  a  pan  can  be  placed  over  a  spirit-lamp  and  slowly  evap- 
orated. The  inhalation  of  moisture-laden  warm  air  is  a 
splendid  means  of  relieving  cough.  The  room  itself  should 
by  no  means  be  allowed  to  become  too  moist ;  80  to  90  per 
cent  of  moisture  in  the  air,  as  shown  by  the  hygrometer, 
is  desirable  in  cases  of  pneumonia,  especially  if  the  cough 
is  distressing. 

After  a  pack  has  been  removed,  a  gentle  dry  rub-down 
over  the  whole  body  should  be  administered.  In  this  way  the 
skin  is  kept  active.  A  local  hot  application  is  made  for 
the  relief  of  pain  in  the  chest.  If  after  the  first  two  or  three 
packs  the  general  condition  of  the  patient  is  improved,  the 
temperature  reduced  and  the  skin  appears  moist,  the  pack 
may  be  given  from  the  feet  to  the  neck.  Physical  and 
psychical  rest  is  of  the  greatest  importance  in  cases  of  this 
kind.  The  bowels  should  be  opened  by  an  enema.  Gentle 
massage  of  the  abdomen  should  be  administered  from  the 
right  iliac  space  upwards  toward  the  liver,  then  horizontally 
across  toward  the  left  hypochondrium,  then  downward 
toward  the  left  iliac  space.  In  this  way  distention  of  the  ab- 
domen is  prevented  and  regular  evacuations  are  promoted. 
(See  DIET  IN  ACUTE  FSVERS.) 

The  regime  indicated  leaves  the  patient's  heart  in  good 


478  MODERN  PHYSIO-THERAPY. 

condition.  The  second  stage  of  the  disease  (exudation, 
red  hepatization)  is  mostly  feared  on  account  of  the  con- 
dition of  the  heart.  The  most  common  cause  of  a  lethal 
result  is  cardiac  failure.  The  arterial  pressure  is  consid- 
erable, the  strain  on  the  right  side  of  the  heart  taxes  the 
organ  to  the  utmost.  The  vaso-motor  exhaustion  is  seen 
in  the  relaxed  peripheral  vessels.  This  grave  condition  of 
affairs  is  best  marked  in  those  cases  that  have  been  sub- 
jected to  the  action  of  heart-irritants  (stimulants,  depress- 
ants). For  this  reason  the  alcoholic  subject  is  notoriously 
a  ready  victim  of  pneumonia.  The  best  argument  in  favor 
of  non-medicinal  treatment  during  the  first  stage  and  the 
enforcement  of  a  strictly  hydro-therapeutic  regime  is  the 
gradual  change  in  the  professional  opinions  concerning  the 
propriety  of  any  special  form  of  medication.  The  best 
clinicians  to-day  recommend  to  open  the  bowels  and  to  ad- 
minister some  therapeutic  agent  to  keep  the  skin  and  the 
kidneys  active.  The  most  favorable  statistics  in  pneumonia 
have  been  furnished  by  the  hydro-therapeutic  institutions 
in  Europe.  (Winternitz.) 

During  the  second  stage  of  the  disease  the  object  of 
treatment  is  to  keep  up  the  heart  and  to  control  hyper- 
pyrexia.  If  the  temperature  exceeds  103°,  cold  sponge- 
baths  should  be  administered  followed  by  a  dry  rub.  The 
temperature  is  not  reduced  by  the  cold  water,  but  by  the 
increased  activity  of  the  skin  which  radiates  heat-units  in 
response  to  stimulation.  To  keep  up  the  heart,  the  patient 
should  remain  in  the  recumbent  posture.  Stimulating  packs 
of  the  lower  extremities  should  be  given  two  or  three  times 
daily.  A  hot  application  to  the  feet  should  be  kept  up  con- 
stantly. The  skin  of  the  lower  extremities  should  be  moist. 
Occasionally  a  lukewarm  sponge-bath,  followed  by  a  dry 
rub,  should  be  given  to  the  lower  limbs.  During  this  stage 
of  the  disease,  judicious  use  of  coffee,  tea  or  of  alcoholic 
stimulants  in  any  form  is  of  advantage. 

Locally  the  use  of  ice-bags  has  been  recommended.  ( See 
reference  to  this  subject  under  INFLAMMATION.)  Recently 


THERAPEUTIC  INDEX.  479 

the  employment  of  intense  dry  heat  (thermic  cylinder)  has 
been  championed.  Neither  the  one  nor  the  other  should 
meet  with  unqualified  endorsement,  although  the  ice-bag 
seems  to  meet  physiological  indications  in  a  certain  sense. 
The  objection  to  extreme  heat  and  extreme  cold  is  clear. 
Both  have  a  tendency  to  suspend  vital  functions  in  the  skin 
and  the  underlying  tissues.  They  produce  anesthesia  by 
paralyzing  the  sensory  nerves.  The  effects  of  either  in- 
tense cold  or  intense  heat  on  the  seat  of  the  disease  are 
illusory.  If  the  temperature  in  the  inflamed  lung-tissue 
can  be  so  lowered  or  so  elevated  as  to  destroy  the  vitality  of 
the  pathogenic  germs,  the  tissue  itself  would  be  impaired, 
because  life  is  not  possible  beyond  certain  physiological  ex- 
tremes of  temperature.  Intense  heat  continuously  applied 
to  the  inflamed  lung  (if  such  could  be  imagined)  would  dis- 
integrate the  aqueous  elements  of  the  blood  by  coagulating 
the  albumen  and  by  destroying  the  white  corpuscles  which 
are  supposed  to  play  the  part  of  phagocytes.  That  the  heart 
is  bound  to  suffer  by  aggravation  of  the  local  reaction,  is 
clear.  The  thermic  cylinder,  locally  us~ed  in  pneumonia, 
seems,  therefore,  to  be  of  questionable  utility.  In  inflamma- 
tory conditions  of  the  pleura  its  use  is  productive  of  good 
results.  The  employment  of  the  ice-bag  in  pneumonia  is 
less  objectionable.  It  frequently  relieves  the  local  symp- 
toms, although  its  exact  physiological  modus  operandi  is 
not  quite  clear. 

Both  for  the  purpose  of  producing  a  local  antiphlogistic 
effect  and  also  to  relieve  pain,  cupping  by  means  of  a 
vacuum  apparatus  is  frequently  useful. 

A  small  portable  faradic  battery  can  frequently  render 
good  service  in  supporting  a  weakening  heart.  Mild  fara- 
dization of  the  vagus  is  a  splendid  heart-tonic. 

To  relieve  headache,  gentle  massage  on  both  sides  of 
the  nape  of  the  neck  or  pressure  over  the  occiput  may  be 
resorted  to.  A  moderately  cold  bath  to  the  face,  followed 
by  stroking  from  the  median  line  of  the  forehead  towards 
and  over  the  temples  on  both  sides  simultaneously  is  a  use- 


480  MODERN  PHYSIO-THERAPY. 

ful  sedative.     In  case  of  threatening'  collapse  the  hypoder- 
mic injection  of  normal  salt  solution  should  be  resorted  to. 

During  the  third  stage  of  the  disease  (resolution,  gray 
hepatization)  the  treatment  does  not  differ  from  the  regime 
during  the  second  stage.  Rest  and  perfect  hygienic  sur- 
roundings should  be  enforced  throughout.  Inhalation  of 
oxygen  or  ozone  is  of  value  in  many  cases.  A  liberal  con- 
structive diet  should  be  allowed  when  convalescence  has 
begun. 

The  therapeutic  suggestions  pertaining  to  the  treatment 
of  acute  pneumonia  practically  contain  the  therapy  of  many 
allied  conditions  such  as  congestion  of  the  lungs,  edema 
of  the  lungs,  hypostatic  pneumonia,  catarrhal  pneumonia, 
etc.  In  conditions  in  which,  owing  to  weak  heart-action, 
blood-stasis  occurs  in  the  most  dependent  portions  of  the 
lungs,  an  occasional  change  in  the  position  of  the  patient 
is  necessary. 

Premature  Labor. — Justifiable  abortion  can  be  induced 
by  secondary  faradic  current  (one  pole  in  uterus,  other 
pole  on  abdomen)  for  five  minutes.  Rapidly  interrupted 
galvanic  current  does  as  well. 

Prostate  Gland  (enlarged). — Newman  advises  nega- 
tive electrolysis  analogous  to  electrolysis  of  strictures.  Cata- 
phoresis  of  K  I  is  advised  by  some  (positive  on  sacrum, 
negative  on  cotton  saturated  with  K  I  solution  to  peri- 
neum). Positive  static  spray  or  wave-current  to  perineum 
and  supra-pubic  region  is  very  soothing.  Hot  vapor  sitz- 
baths  and  hot  rectal  injections  are  useful. 

Pruritus  Vulvae. — After  enforcing  absolute  cleanliness 
of  the  vagina,  an  application  of  positive  galvanic  electricity 
(five  milliamperes  for  five  to  ten  minutes  every  day)  should 
be  made.  A  local  positive  static  spray  is  very  useful.  The 
high-frequency  current  applied  by  means  of  a  flat  vacuum- 
electrode  is  very  serviceable.  Cold  douches  to  the  vulva 
improve  the  local  circulation  and  skin-function.  The  local 
electric-light  bath  is  very  valuable  for  the  same  reason. 

Reflex  Disorders. — Xerve-function  may  be  disturbed 
by  conditions  of  auto-intoxication.  (See  FUNCTIONAL  Dis- 


THERAPEUTIC  INDEX. 


ORDERS.)  In  addition  to  this  the  influence  of  sense-im- 
pressions received  by  the  organs'  of  special  sense  ( skin,  eyes, 
ears,  nose,  tongue)  is  an  element  of  importance  in  the  causa- 
tion of  many  so-called  reflex  disorders.  Last  but  not  least, 
the  mind  has  a  controlling  interest  in  the  economy.  An  im- 
petus received  by  the  mind  (psychic  impression)  or  by  the 
organs  of  special  sense  is  capable  of  increasing,  decreasing 
and  otherwise  altering  the  nutrition  and,  therefore,  the  ac- 
tivity of  the  nerves.  The  sympathetic  nervous  system  is 
the  one  incalculable  factor  in  the  functional  potency  of  the 
whole  organism.  Its  action  is  past  human  ken  and  specula- 
tion. It  is  the  eternally  personal  and  soul  element  in  the  in- 
dividual body.  It  is  the  one  factor  which  creates  the  ever- 
changing  variability  of  subjective  disease-symptoms.  The 
sympathetic  nervous  system  is  in  touch  with  every  fiber  and 
cell  in  the  body.  Thus  it  is  that  impulses  reverberating 
through  its  exquisitely  fine  network  may  cause  sympathetic 
vibration  anywhere  and  everywhere  in  the  organism.  The 
path  along  which  the  impulses  travel  have  as  yet  not  been 
explored  by  either  chemist  or  physiologist.  As  long  as  they 
are  not,  the  pathology  of  most  reflex  disorders  will  remain 
'a  biologic  mystery. 

Inasmuch  as  many  reflex  disorders  are  true  conditions  of 
auto-intoxication,  the  therapy  of  the  latter,  as  indicated 
under  the  head  of  FUNCTIONAL  DISORDERS,  is  applicable  in 
their  treatment.  Frequently  the  so-called  reflex  disorders 
are  produced  by  impulses  received  by  the  mind  and  the  or- 
gans of  special  sense.  The  mind  and  the  special  senses  are, 
as  it  were,  receiving  stations  through  which  the  nervous  sys- 
tem communicates  with  the  outer  world.  We  know  that  the 
organism  can  be  reached  through  these  open  gates  by  im- 
pulses addressed  to  the  receivers  and  transmitted  by  them 
to  the  nervous  system.  It  is  plain  that  such  impulses,  if 
they  are  properly  applied,  can  serve  a  therapeutic  purpose. 
Therein  lies  the  therapy  of  suggestion  and  of  the  different 
agencies  which  are  capable  of  acting  upon  the  sight  and 
hearing  and  the  other  special  senses. 


482  MODERN  PHYSIO-THERAPY. 

Suggestion  is  unconsciously  practiced  by  physicians  at 
all  times.  It  is  the  one  all-important  factor  that  makes  or 
breaks  a  physician.  Let  him  practice  suggestion  consciously 
and  for  a  purpose,  not  only  on  the  patient  but  on  the  pa- 
tient's surroundings.  The  control  of  mind  over  mind  pri- 
marily, and  mind  over  body  secondarily,  is  the  one  great 
psycho-physiological  marvel  in  practical  medicine.  Inas- 
much as  the  so-called  reflex  disorders  represent  a  vast  pro- 
portion of  chronic  nervous  diseases,  suggestion  is  necessary 
to  control  the  subtle  caprices  of  nerve-action  that  mark  these 
reflex-disorders.  That  physical  effects  can  be  produced  by 
suggestion,  no  one  disputes.  If  it  were  not  possible,  the 
world  would  never  have  known  anything  of  so-called  mira- 
cles. The  rest-cure,  as  advocated  by  S.  Weir  Mitchell,  is  a 
negative  illustration  of  this  subject.  Absolute  rest  is  en- 
forced in  order  to  put  an  end  to  untoward  suggestive  in- 
fluences of  surroundings. 

The  special  senses  can  be  acted  upon  for  therapeutic 
purposes  in  the  treatment  of  morbid  reflexes.  The  sug- 
gestive influence  of  colors  is  undeniable.  Whatever  we  see 
has  color.  The  nervous  system  responds  to  these  impulses. 
Experimentally  it  has  been  shown  that,  beginning  with  the 
thermic  end  of  the  solar  spectrum,  the  red,  orange,  yellow, 
green,  blue,  indigo  and  violet  radiations  have  irritating, 
stimulating,  sedative  and  hypnotic  effects,  respectively,  on 
the  system.  Color-effects  can  be  added  to  the  patient's  sur- 
roundings in  order  to  stimulate  or  quiet  the  nervous  system. 
The  adaptation  of  the  means  to  the  end  will  depend  on  the 
therapeutic  requirements  of  the  individual  case.  Morbid 
reflexes  might  be  due  to  the  effects  of  a  certain  color  on 
the  patient's  eyes  and  skin.  Charcot  speaks  of  a  lady  who 
suffered  from  a  nervous  headache  which  would  not  yield. 
The  headache  became  worse  when  the  lady  returned  to  her 
room,  which  was  decorated  with  gay  colors,  red  predominat- 
ing. Charcot  suggested  to  the  lady  to  take  another  room, 
with  blue  wall-paper  and  plain  furnishings.  The  reflex 
headache  promptly  disappeared.  The  same  author  speaks 


THERAPEUTIC  INDEX.  483 

of  the  advantage  of  gay  colors  in  the  treatment  of  certain 
forms  of  melancholia.  (See  chapter  on  THE  THERAPY  OF 
LIGHT.) 

The  skin  is  not  infrequently  the  origin  of  reflex  disor- 
ders. The  case  of  a  woman  is  recorded  who  suffered  from 
enuresis  whenever  she  wore  woolen  underwear.  The 
enuresis  was  purely  a  reflex  disorder  produced  by  an  irrita- 
tion received  and  transmitted  by  the  skin.  The  necessity  of 
giving  the  skin  some  prophylactic  and  therapeutic  consid- 
eration in  the  presence  of  obscure  reflex  disorders,  is  ap- 
parent. 

The  sense  of  hearing  readily  receives  impressions  that 
react  en  the  nervous  system.  Therapeutically  this  has  been 
demonstrated  by  the  effects  which  sound  is  capable  of  pro- 
ducing on  the  human  organism,  both  in  conjunction  with 
and  independent  of  melody,  harmony  and  rhythm.  The 
therapy  of  sound  (music)  ought  to  receive  more  serious  at- 
tention than  lias  heretofore  been  accorded  to  it.  Its  avail- 
ability in  the  correction  of  morbid  reflexes  has  been  amply 
demonstrated.  It  is  not  a  question  of  attributing  certain 
effects  to  a  certain  kind  of  music  under  any  and  all  circum- 
stances, although  there  can  be  no  doubt  that  scientific  ex- 
perimentation will  clear  up  much  of  the  speculative  nature 
of  the  subject.  The  character  of  the  existing  reflex  disor- 
der and  the  personal  equation  of  the  patient  are  important 
factors.  A  German  neurologist  was  in  the  habit  of  admin- 
istering to  his  hysterical  patients  suggestions  in  the  form  of 
suitable  musical  selections.  One  woman  was  suffering  from 
a  hysterical  paralysis  of  the  lower  extremities.  The  acoustic 
therapy  consisted  in  the  daily  rendition  of  a  Strauss  waltz 
played  in  the  most  fascinating  and  suggestive  manner  every 
two  hours.  After  two  days  the  spell  was  broken.  The  pa- 
tient danced.  In  another  patient  maniacal  manifestations 
were  subdued  by  full  chords  played  softly  and  slowly  in  a 
darkened  room.  A  case  of  hysteria  was  relieved  of  dys- 
phagia  by  the  Sextette  from  Lucia  and  selections  of  a  simi- 
lar character.  Music  in  these  cases  is  the  carrier  of  the 


484  MODERN  PHYSIO-THERAPY. 

suggestive  influence.  Its  availability  and  power  in  this  ca- 
pacity can  only  be  appreciated  by  those  who  have  had  oc- 
casion to  witness  demonstrations  of  the  efficacy  of  acoustic 
therapy. 

The  gustatory  and  olfactory  senses  are  closely  allied  to 
reflex  disorders.  I  know  of  a  physician  who  attributes  at- 
tacks of  sciatica  to  the  odor  of  certain  drugs,  notably  penny- 
royal. That  the  smell  of  certain  flowers  is  capable  of  caus- 
ing depression  of  the  nervous  system,  even  to  the  point  of 
anesthesia,  is  well  known.  That  the  odors  of  some  flowers, 
when  inhaled  by  certain  persons  while  asleep,  may  produce 
singular  nervous  phenomena  in  those  persons  after  they 
have  awakened,  has  likewise  been  observed.  These  effects 
are  reflex  disorders  due  to  what  appears  to  be  a  toxic  con- 
dition of  the  nerves  of  smell. 

Suggestions  addressed  to  the  nervous  system  through 
the  brain  or  the  special  senses  are  agents  of  unquestioned 
power  in  the  treatment  of  obscure  reflex  disorders.  The  thera- 
peutic directions  referred  to  are  given  in  all  seriousness. 
I  am  not  unmindful  of  the  fact  that  the  subject  of  suggest- 
ive influence  such  as  outlined  above  can  not  be  formulated, 
analyzed  and  systematized  in  the  strictly  scientific  manner 
which  modern  medicine  expects  and  demands  of  therapeutic 
agents.  Yet  these  suggestive  agents  have  unquestioned 
power,  even  if  the  latter  is  ill-defined  and  oscillating.  The 
worst  that  could  be  said  in  regard  to  them,  holds  good  in 
regard  to  much  of  the  drug-therapy  of  torday  with  its  un- 
certainty of  physiological  action  and  its  ever-ready  psychic 
efficacy. 

Rheumatism. — That  rheumatism  is  a  disorder  of  metab- 
olism and  that  certain  predisposing  conditions  of  tempera- 
ture, climate,  environment,  diet,  habits,  etc.,  are  capable  of 
producing  it,  all  physicians  are  agreed.  Objectively  it  pre- 
sents itself  as  the  local  expression  of  a  general  disturbance, 
or  rather  as  a  general  disturbance  with  local  expressions. 
The  term  "auto-intoxication"  in  its  wide  biological  sig- 
nificance expresses  the  pathology  of  rheumatism  perfectly. 


THERAPEUTIC  INDEX.  485 

It  is  of  no  consequence  whether  we  look  upon  this  disease  as 
belonging  under  the  acute  infections.  The  pathology  of  the 
affliction  teaches  us  that  the  outward  conditions  named 
above  and  the  internal  elements  of  disturbed  metabolism  are 
primarily  concerned  in  the  causation  of  the  rheumatic  state. 
That  germs  might  develop  under  these  conditions  is  not  im- 
probable ;  that  toxines  derived  from  germ-growth  might  add 
an  element  to  the  sum-total  of  the  symptomatic  evidences  of 
the  disease  is  quite  likely.  The  essence  of  the  disease  proc- 
ess, however,  is  some  disproportion  in  the  intake  of  food  and 
output  of  waste,  using  the  latter  term  in  its  widest  physiolog- 
ical sense.  The  disproportion  arises  from  the  retention  in 
the  blood  of  waste-products  of  oxidation  and  the  formation 
and  absorption  of  toxines  from  the  retained  excreta. 

When,  through  any  external  agency  or  cause  whatsoever, 
the  nervous  mechanism  which  presides  over  the  assimila- 
tion of  supplies  and  the  expulsion  of  waste  is  disturbed  so 
as  to  be  unable  to  dispose  of  the  ultimate  derivatives  of  the 
tissue-building  foods  (principally  uric  acid  and  C  O2)  and 
excrete  them  through  the  natural  channels,  the  result  is  a  re- 
tention of  a  part  of  these  derivatives  and  their  products  in 
the  system  and  a  consequent  condition  of  poisoning.  These 
poisons  may  give  rise  to  any  number  of  toxemic  conditions 
depending  on  the  manner  in  which  they  attack  the  organism 
or  any  special  part  thereof.  Under  suitable  conditions  this 
toxemia  might  present  itself  in  a  most  tempestuous  manner, 
characterized  by  hyperpyrexia  and  severe  inflammatory 
phenomena  on  the  part  of  certain  structures  which  draw 
large  quantities  of  secretion  from  the  vitiated  blood-fluid 
and  become  inflamed  as  a  result  (serous  membranes  .of 
joints,  pleura,  peritoneum,  pericardium,  etc.).  Why  this 
selective  action  of  the  vitiated  fluids  of  the  blood  should  af- 
fect certain  structures  more  than  others  is  probably  due  to 
the  fact  that  the  number  of  lymph-glands  is  .proportionately 
greater  near  joints,  that  the  veins  are  tortuous  in  these  re- 
gions and  carry  relatively  more  venous  blood,  and  that,  as  a 
result,  the  effects  of  disturbed  metabolism  are  more  keenly 


486  MODERN  PHYSIO-THERAPY. 

felt  by  the  structures  surrounding  a  joint.  That  the  tissues 
concerned  in  the  functions  of  motion  (joints,  muscles) 
should  be  more  frequently  the  seat  of  rheumatism  is  easily 
understood  when  we  consider  the  more  active  oxidation 
which  is  constantly  taking  place  in  these  structures.  The 
same  reason  might  explain  the  liability  of  serous  membranes 
to  rheumatic  irritation.  They  are  functionally  most  active. 
This  would  be  the  etiology  and  pathology  of  the  acute  ar- 
ticular variety  of  rheumatism,  or  in  a  less  severe  and  more 
protracted  form,  of  chronic  articular  rheumatism.  That 
these  structures  are  readily  affected  by  other  kinds  of  toxines 
besides  the  derivatives  of  the  tissue-building  foods,  is  shown 
by  the  irritating  action  of  gonorrheal  toxines  in  the  blood, 
manifesting  their  presence  by  the  appearance  of  a  gonor- 
rheal arthritis  (gonorrheal  rheumatism)  in  the  proximate 
joints.  The  toxemia  might  be  of  a  comparatively  mild  type 
and  show  itself  locally  by  affecting  certain  regions,  muscles 
or  other  places  of  lessened  resistance  (muscular  rheumatism, 
torticollis,  lumbago,  pleurodynia,  etc.).  The  toxines  may 
gradually  accumulate  and  attack  one  joint  or  two  (gout). 
In  the  latter  condition  the  activity  of  gravitation  is  probably 
a  factor  of  some  importance.  Both  in  muscular  rheumatism 
and  in  gout  the  action  of  the  direct,  exciting  cause  may  de- 
termine the  character  of  the  attack.  Thus  in  a  predisposed 
subject  exposures  to  a  draught  might  result  in  a  local  meta- 
bolic disturbance  affecting  the  sterno-cleido-mastoid  muscle 
and  resulting  in  a  stiff  neck  (torticollis).  In  another  (pre- 
disposed) subject  the  indulgence  in  pleasures  of  the  table 
might  cause  the  disturbance  of  metabolism  to  explode  in 
the  big  toe  and  produce  an  acute  attack  of  gout.  In  a  third 
individual  the  muscles  of  the  back  are  sore  (lumbago)  as 
the  result  of  exposure  to  cold.  The  cold  draught  causes 
contraction  of  the  cutaneous  vessels.  The  blood  is  forced 
into  deeper  tissues.  Stagnation  takes  place  in  the  deep  tis- 
sues. Waste-products  accumulate.  The  small  nerve-fila- 
ments suffer  from  the  want  of  fresh  blood  and  are  sur- 
charged with  an  excess  of  C  Q2.  The  result  is  the  pain  of 


THERAPEUTIC  INDEX.  487- 

Inmbago.  If  "reaction"  had  occurred  after  the  forcible 
contraction  of  the  cutaneous  vessels  took  place  in  response 
to  a  draught,  there  would  have  been  no  stagnation,  no  ac- 
cumulation of  waste-products,  no  lumbago.  The  overtower- 
ing  importance  of  "reaction"  is  clear  to  every  thoughtful 
hydro-therapeutist.  Why  did  not  reaction  set  in  after  the 
blood  had  been  foiced  into  deeper  vessels?  Why  did  not 
hyperemia  in  the  primary  area  follow?  (See  chapter  on 
THERAPEUTIC  EFFECTS  OF  HEAT  AND  COLD.)  The  presence 
of  uric  acid  toxines  in  the  blood  has  impaired  the  functional 
power  of  the  local  vaso-motor  nerves.  This  is  what  is  meant 
by  rheumatic  predisposition.  It  is  the  remote  cause  of  the 
attack  while  the  cold  draught  is  the  exciting  cause.  All  this 
goes  to  show  ( i )  that  the  various  kinds  of  rheumatism  are 
due  to  the  same  cause  acting  under  different  .conditions, 
and  (2.)  that  success  in  the  treatment  of  all  rheumatic  con- 
ditions is  in  direct  proportion  to  our  ability  to  restore  the 
disturbed  metabolism  generally  and  locally.  Since,  however, 
the  metabolic  disturbance  consists  in  deficient  oxidation,  it 
is  plain  that  the  rational  treatment  of  rheumatism  consists  in 
intensifying  oxidation  and  increasing  the  expulsion  of  waste. 

In  view  of  what  has  been  said,  we  are  prepared  to  look 
upon  rheumatism  in  all  its  forms  as  being  due  to  accumu- 
lation in,  and  absorption  into,  the  system  of  waste-products. 
It  is  a  common  affliction  of  meat-eaters  because  of  the  in- 
ability of  the  organism  to  excrete  the  uric  acid  which  is  in 
excess.  It  frequently  attacks  persons  whose  circulation  is 
poor.  Stagnation  of  the  intestinal  excreta  may  produce  it, 
as  shown  by  the  beneficial  results  of  active  catharsis  in  these 
cases.  Not  very  many  years  ago  an  optimist  declared  colon- 
irrigation  to  be  a  specific  in  rheumatism.  That  it  has  a  cura- 
tive effect  in  selected  cases,  there  is  no  doubt.  Enough  has 
been  said  to  indicate  the  principles  of  rational  treatment,  to 
wit: 

i.  Forced  excretion  and  expulsion  of  waste  by  powerful 
stimulation  of  the  excretory  organs ; 


488  MODERN  PHVSIO-THERAPY. 

2.  Regulation  of  the  physiological  supplies  to  lessen  or 
1  're vent  waste-accumulation  ; 

3.  Increased  oxidation  to  help  in  the  re-establishment  of 
the  physiological  proportion  between  the  burning  of  fuel  and 
the  expulsion  of  slack ; 

4.  To  give  symptomatic  relief  while  the  physiological 
treatment  is  in  progress. 

These  directions,  in  a  varied  sense  to  meet  individual  re- 
quirements, hold  good  in  all  rheumatic  conditions  (acute  and 
chronic  articular  rheumatism,  muscular  rheumatism,  gout). 
Therapeutically  the  modes  of  treatment  might  be  classified 
as  general  or  local,  according  as  they  aim  at  correcting  un- 
derlying systemic  conditions  or  relieving  local  manifesta- 
tions. For  the  sake  of  convenience  it  might  be  wise  to  con- 
sider gout  and  the  muscular  variety  of  rheumatism  sep- 
arately because  they  have  characteristic  clinical  features  of 
their  own.  The  management  of  the  inflammatory  varieties 
(acute  and  chronic  articular  rheumatism)  is  practically 
identical.  The  advantages  of  the  hospital  or  sanitarium 
where  all  modern  therapeutic  aids  in  the  treatment  of  rheu- 
r.iatism  are  available,  are  apparent. 

ACUTE;  AND  Cnuoxic  ARTICULAR  RHEUMATISM. — In  or- 
der to  accelerate  and  intensify  the  expulsion  of  waste  it  is, 
above  all  things,  necessary  to  open  the  bowels  by  repeated 
irrigation  of  the  colon,  or,  if  the  patient  can  not  be  handled 
without  causing  great  pain,  by  rectal  injections.  To  flush 
out  the  kidneys,  allow  the  patient  to  drink  copious  quan- 
tities of  fresh,  clear  water.  The  latter  direction  holds  good 
in  all  rheumatic  cases.  Water  dilutes  the  offensive  waste 
and  helps  in  the  excretion  of  the  latter  through  the  kidneys 
and  through  the  skin.  The  sick-room  should  be  light,  airy 
and  well-ventilated.  Exposure  of  aching  joints  to  sunlight 
\\as  recommended  as  early  as  in  the  days  of  Hippocrates. 
The  skin  must  be  stimulated  by  suitable  means.  If  the  pa- 
tient is  totally  helpless  and  can  not  be  handled  without  great 
pain,  a  general  hot  moist  pack  can  be  applied.  If  tbe  weight 
of  the  pack  is  not  well  borne  by  the  patient,  a  hot  vapor- 


T  ii  KR  A  PHUT  ic  INDEX. 


bath  should  be  improvised  as  suggested  in  the  treatment  of 
cxanthematous  fevers.  (See  FuvER. )  A  bath  of  this  kind 
can  be  given  once  or  twice  daily  and  may  be  followed  by  a 
pack  if  the  patient  stands  the  copious  diaphoresis  well.  This 
is  shown  by  the  pulse  and  the  respiration.  Reduction  of 
the  body-temperature  after  each  bath,  and  a  general  decline 
of  the  pyrexia  after  a  series  of  baths,  are  good  prognostic 
signs.  If  the  patient  can  be  handled,  nothing  equals  the 
efficacy  of  the  dry-heat  body-cylinder.  The  object  of  a  dry- 
litat  bath  in  these  cases  is  to  cause  diaphoresis  and  for  this 
reason  the  duration  of  the  treatment  is  of  greater  moment 
than  the  degree  of  heat  employed.  Ordinarily  200°  to 
-•50°  F.  for  forty-five  to  sixty  minutes  are  sufficient  to  pro- 
duce a  complete  therapeutic  effect.  If  the  patient  stands 
the  treatment  well,  the  so-called  after-sweat  will  enhance 
the  therapeutic  effect.  Ordinarily  it  is  proper  to  rub  the 
patient  down  with  lukewarm  water  and  add  massage  over 
regions  which  are  not  painful  but  are  contiguous  to  the  af- 
fected parts.  Dry-heat  baths  are  more  trying  to  a  rheumatic 
subject  than  vapor-baths  and  for  this  reason  can  not  be  as 
frequently  administered.  The  same  may  be  said  of  the 
electric-light  bath,  which  is  an  agent  of  wonderful  power 
in  rheumatic  cases,  but  must  be  used  with  great  care  and 
discretion.  One  of  these  dry-heat  or  electric-iight  baths 
can  be  given  every  day  or  two.  If  the  weather  permits,  the 
l>;itient  will  derive  a  world  of  good  from  a  continued  sun- 
bath. 

In  administering  any  of  the  powerful  sweat -producing 
baths,  it  is  wise  to  inquire  into  the  medicinal  treatment 
vrhich  a  patient  might  have  had  previously.  One  of  these 
baths  is  sufficient  to  cause  acute  symptoms  of  iodism  or 
salicylic-acid  poisoning  if  iodides  or  salicylates  have  been 
administered  for  a  few  days  previous  to  the  diaphoretic 
treatment.  The  latter  seems  to  provoke  accumulative  ef- 
fects of  the  drugs. 

To  lessen  or  prevent  the  accumulation  of  uric  acid  in 
the  system,  it  is  necessary  to  administer  food  which  will  help 


490  MODERN  PHYSIO-THERAPY. 

in  the  oxidizing  process  without  forming1  much  slack.  This 
makes  the  carbo-hydrates  the  ideal  food-stuffs  for  rheu- 
matics. Avoid  meat,  eggs,  beans,  peas,  salt,  pepper,  mus- 
tard, all  spices  and  highly  seasoned  foods,  coffee,  tea,  alcohol 
in  any  form,  in  fact  all  foods  that  are  not  bland,  light  and 
easily  assimilated.  An  excellent  food  as  well  as  refreshing 
beverage,  sanctioned  alike  by  the  advice  of  all  experienced 
grandmothers  and  by  the  clinical  records  of  dietetic  insti- 
tutions, is  buttermilk.  It  can  be  given  at  all  times  and  in 
any  quantity,  provided  the  patient's  palate  or  stomach  does 
not  rebel  against  it.  Water  can  be  freely  given.  Sweet  milk 
is  an  excellent  food  for  rheumatics.  On  general  principles 
the  enforcement  of  a  rigorous  exclusive  vegetable  diet  is 
indicated  in  all  cases  of  rheumatism.  The  diet  may  include 
vegetable  soups  (except  bean  or  pea),  raw  oysters,  bread, 
oatmeal,  toast,  Zwieback,  crackers,  rice,  milk-pudding,  fresh 
fruit  unless  excessively  acid,  potatoes  and  occasionally,  if 
the  patient  desires  it,  a  cup  of  very  weak  tea,  preferably 
without  milk  or  sugar. 

The  dietetic  regime  of  Schroth  known  as  the  "Trocken- 
kur,"  has  been  successfully  used  in  many  cases  of  rheuma- 
tism. It  is  discussed  under  the  head  of  SYPHILIS. 

In  the  management  of  the  local  manifestations  o-f  artic- 
ular rheumatism,  i.  e.  inflamed  joints,  dry  heat  is  admittedly 
the  foremost  therapeutic  agent.  A  cylinder  of  suitable  size 
is  employed  for  this  purpose.  The  patient  is  put  in  a  com- 
fortable position,  the  part  or  region  to  be  baked  is  wrapped 
in  three  layers  of  Turkish  toweling,  introduced  into  the  dry- 
heat  cylinder,  where  it  rests  upon  a  hammock  and  the  ends 
of  the  cylinder  closed  by  means  of  hoods  provided  for  this 
purpose.  The  hot  air  must  not  come  in  contact  with  any 
uncovered  skin.  Any  part  of  the  skin  exposed  to  the  heat 
must  be  properly  covered  as  indicated  above.  The  prepara- 
tions being  thus  properly  made,  the  heat  is  turned  on.  For 
local  applications  of  this  kind  ?oo°  to  450°  F.  are  suitable 
and  productive  of  much  benefit.  Treatments  of  this  kind 
should  last  thirty  minutes  and  longer.  The  physiological 


THERAPEUTIC  INDEX.  491 

effect  aimed  at  differs  most  decisively  from  that  of  the  gen- 
eral application  in  the  body-apparatus.  Stimulation  of  skin- 
function  is  secondary  to  the  effects  of  intense  heat  per  se. 
The  object  of  the  local  application  is  to  increase  the  arterial 
blood-supply  and  in  this  way  to  stimulate  the  venous  and 
lymphatic  circulation.  In  this  way  the  local  metabolism  re- 
ceives a  most  powerful  impetus,  the  effect  being  a  physio- 
chemical  regeneration  of  the  part.  The  whole  region  is 
heated  up,  the  rise  in  the  local  temperature  being  coincident 
with  more  intense  oxidation  and  tissue-change.  The  sec- 
ondary effect  of  active  diaphoresis  helps  to  deplete  the  part 
and  to  diminish  the  amount  of  inflammatory  exudates.  The 
lessened  pressure  is  experienced  by  the  patient  as  a  distinct 
relief  from  pain.  Treatment  of  this  kind  can  be  given  daily 
and  even  oftener.  After  the  treatment  the  part  should  be 
allowed  to  rest  for  an  hour,  when  it  can  be  subjected  to 
massage  or  any  other  additional  treatment  deemed  neces- 
sary. The  technique  of  dry-heat  treatments  is  of  the  great- 
est importance.  The  occurrence  of  burns  is  most  deplor- 
able because  it  prejudices  the  patient  against  further  ther- 
,mic  treatment.  Burns  of  this  kind  are  very  stubborn.  To 
prevent  burning  the  toweling,  the  latter  can  be  prepared  by 
being  immersed  in  the  following  solution  which  makes  it 
fire-proof.  The  solution,  which  is  recommended  by  C.  E. 
Skinner,  is  as  follows : 

Thirty  ounces  of  water  in  which  enough  tungstate  of 
sodium  is  dissolved  to  make  a  saturated  solution.  To  this 
add  six  ounces  of  water  containing  two  ounces  of  phos- 
phate of  sodium.  The  toweling  is  soaked  in  this  solution, 
hung  up  in  an  oven  containing  350°  F.  until  dry.  The 
tungstate  precipitate  which  remains  in  the  fiber  makes  it 
fire-proof.  Personally  I  know  nothing  about  this  process. 
With  ordinary  care  thermic  treatments  can  be  given  without 
untoward  accidents.  The  electric-light  bath  is  an  adequate 
substitute  for  the  dry-heat  cylinder. 

An  hour  after  the  thermic  treatment,  the  affected  area, 
if  the  inflammatory  condition  is  comparatively  mild,  can  be 


492  MODERN  PHYSIO-THERAPY. 

subjected  to  kneading  and  centripetal  massage.  Vibration 
along  the  neighboring  lymph-channels  is  of  value.  In  acute 
cases  the  affected  area  should  not  be  manipulated  after  the 
thermic  treatment.  Massage  applied  to  the  contiguous 
structures  is  permissible  and  beneficial.  In  a  general  way  it 
might  be  stated  that  massage  and  electricity  should  be  re- 
served for  the  subacute  or  chronic  forms  of  articular  rheu- 
matism. 

Galvanism  may  be  advantageously  employed  in  the  sub- 
acute  and  chronic  form  of  rheumatism.  Place  one  pole  on 
cither  side  of  the  affected  part  (ten  milliamperes  for  ten  min- 
utes daily).  If  the  negative  pole  causes  pain,  place  it  at  a 
distance.  The  affected  part  can  be  immersed  in  water,  the 
latter  being  used  as  the  conductor  of  the  positive  current. 
A  static  brush-discharge  (wooden  electrode)  and  the  wave- 
current  answer  well  in  many  cases.  High-frequency  cur- 
rents have  a  fine  effect  on  local  metabolism.  Some  recom- 
mend cataphoresis  of  lithium  salts  (positive  sponge  sat- 
urated with  a  solution  and  applied  locally). 

After  a  joint  has  ceased  to  be  painful,  massage  is  of  the 
greatest  value.  Deep  kneading  and  centripetal  stroking  will 
do  much  towards  restoring  the  part.  Faradism  is  useful  to 
tone  up  the  muscles  and  prevent  loss  of  muscular  power. 
During  the  course  of  rheumatic  inflammation  of  a  joint 
many  uncommon  features  might  arise.  Locally  leeches, 
cupping,  etc.,  may  be  required.  Ice-applications  are  harm- 
ful. The  rheumatic  condition  might  involve  other  struc- 
tures, especially  the  serous  membranes.  Treatment  must  be 
adapted  to  circumstances.  At  all  times,  however,  the  gen- 
eral regime,  as  suggested  above,  must  be  adhered  to,  and, 
if  necessary,  still  more  heroically  enforced.  The  results  of 
the  physio-therapeutic  treatment  of  rheumatism  have  robbed 
the  salicylates  of  much  of  their  glory  as  alleged  specifics. 
The  salicylates  do  not  enhance  the  therapeutic  effects  of  the 
agents  spoken  of,  but  frequently  ruin  the  stomach  and  make 
a  chronic  case  out  of  an  acute  attack.  Coal-tar  products  are 
harmful  because  they  deoxidize  the  blood  by  destroying  the 


THERAPEUTIC  INDEX. 


hemoglobin  and,  therefore,  aggravate  the  general  state  of 
the  system  which  made  the  development  of  rheumatism  pos- 
sible. Least  objectionable  are  the  alkaline  waters  so  fre- 
quently resorted  to  as  anti-rheumatic  remedies,  although 
their  therapeutic  value  is  likely  to  be  overrated.  They  are 
certainly  not  equal  to  the  sulphate  of  magnesia,  which  by 
its  dehydrating  and  cathartic  action  promotes  the  excretion 
of  waste  and  the  restoration  of  normal  metabolism. 

In  the  go n or r heal  variety  of  articular  rheumatism  the 
treatment  would  consist  in  dry  heat  locally,  active  peristalsis, 
vegetable  diet,  and  suitable  therapy  to  remove  the  real  cause. 
Bier's  stasis  has  been  employed  successfully  in  these  cases. 

Rheumatism  (Muscular). — The  principles  of  treatment 
do  not  differ  from  those  underlying  the  therapeutic  man- 
agement of  articular  rheumatism.  The  greatest  value  is  to 
be  attributed  to  massage,  heat  and  electricity.  In  all  forms 
of  muscular  rheumatism  the  dietetic  regime  as  outlined  un- 
der the  head  of  articular  rheumatism  must  be  rigorously  en- 
forced, the  bowels  must  be  kept  open  and,  if  the  general  con- 
dition of  the  patient  indicates  sluggishness,  the  dry-heat 
body-cylinder  or  the  general  electric-light  bath  should  be 
resorted  to. 

TORTICOLLIS. — Effleurage  over  the  aching  stiffened  mus- 
cle, first  gentle  and  superficial,  afterwards  deep  and  firm, 
and  followed  by  vibration,  ought  to  practically  cure  the  pa- 
tient. If  necessary  the  part  can  be  exposed  to  the  Minin 
light,  the  face  and  healthy  part  of  neck  having  been  covered 
with  towels.  The  application  of  the  wave-current  or  the 
static  positive  brush-discharge  (wooden  electrode)  is  bene- 
ficial. The  galvanic  current  (positive  to  affected  muscle, 
negative  to  other  side  of  neck)  or  faradic  current  applied 
to  aching  muscle  will  remove  pain  and  restore  mobility. 

PLEURODYNIA. — Treatment  is  the  same  as  in  cases  of 
wry-neck.  The  larger  the  area  of  the  affected  muscular 
tissue,  the  more  effective  will  be  the  use  of  the  general  treat- 
ment by  means  of  a  body-cylinder  or  electric-light  bath. 
Locally  the  most  remarkable  results  can  be  promptly 


494  MODERN  PHYSIO-THERAPY. 

achieved  by  massage  and  vibration.  Immobilization  by  ad- 
hesive straps  is  frequently  of  value. 

LUMBAGO. — Local  application  of  heat  by  a  small  dry- 
heat  cylinder  is  an  excellent  anodyne  and  counter-irritant. 
Deep  massage  and  vibration  with  due  regard  to  the  sensi- 
bilities of  the  patient  should  be  judiciously  added.  The 
positive  indirect  static  breeze,  the  wave-current,  the  gal- 
vanic current  (positive  pole  to  aching  muscles)  relieve  pain 
very  promptly.  All  positive  applications  should  be  com- 
bined with  deep  vigorous  massage.  Swedish  movements  to 
engage  the  lumbar  muscles  can  be  begun  after  the  pain  has 
disappeared.  The  cold  douche  to  the  lumbar  region  is  ex- 
cellent. Strapping  the  back  by  means  of  adhesive  plaster 
is  frequently  required  in  the  interval  between  treatments. 

Rheumatoid  Arthritis  (Arthritis  Deformans). — That 
this  obdurate  and  destructive  disease  belongs  under  the  head 
of  true  rheumatic  afflictions,  there  seems  to  be  no  doubt.  It 
is  rheumatism  in  the  trophic  nerves  of  the  joints  and  usually 
affects  rheumatic  subjects  who  have  suffered  frequent  at- 
tacks of  articular  rheumatism.  The  trophic  nerves,  as  a 
result  of  the  rheumatic  infection,  are  functionally  impaired 
and  perverted  trophic  (nutritional,  developmental)  processes 
take  place  in  and  near  the  joints.  Some  doubt  the  true 
rheumatic  character  of  the  etiology  and  point  to  heredity, 
frequent  pregnancies,  bad  hygiene,  psychic  impressions, 
worry,  etc.,  as  causative  factors  in  many  cases.  The  prog- 
nosis, as  far  as  the  local  condition  is  concerned,  is  bad  be- 
cause the  cause  is  usually  beyond  reach. 

Local  treatment  seems  to  be  of  no  avail.  Improve  the 
patient's  general  health  by  sunlight,  fresh  air,  exercise,  open 
emunctories,  mild  but  invigorating  diet,  etc.  The  body- 
cylinder  is  useful.  General  high-frequency  treatments 
(cage  or  diasolenic)  are  very  beneficial.  Vibration  and 
static  sprays  along  the  spine  should  always  be  resorted  to. 
If  the  local  symptoms  require  it,  administer  local  treatment 
in  keeping  therewith  and  according  to  the  directions  which 
have  been  given  under  the  head  of  articular  rheumatism. 


THERAPEUTIC  INDEX.  495 

Salpingitis. — (See  INTRA-PELVIC  INFLAMMATIONS.)  In 
the  chronic  form  galvanism  (positive  pole  in  cul-de-sac  near 
affected  part,  negative  pole  on  back,  ten  to  fifteen  milliam- 
peres  for  fifteen  minutes  every  second  day)  is  useful.  Gen- 
eral directions  under  INFLAMMATION  (CHRONIC). 

Sarcoma. — Negative  electrolysis  (multiple  needle).  (See 
INOPERABLE  MALIGNANT  DISEASE  and  chapter  on  X-RAY 
THERAPY.  ) 

Sepsis  (Local). — The  treatment  of  an  acute  abscess  or 
acute  localized  suppuration  is  to  all  intents  and  purposes  a 
surgical  problem.  Abscess  or  localized  pus-formations  may 
be  large  or  small.  They  may  be  diffused  or  circumscribed. 
They  may  be  due  to  the  activity  of  any  number  of  pus-pro- 
ducers. Thus  the  local  sepsis  may  be  a  stitch-hole  abscess,  a 
felon,  a  furuncle,  a  carbuncle,  a  suppurating  bubo,  an 
empyema.  The  predisposing  cause  of  local  pus-production 
should  receive  the  first  attention  of  the  physician,  e.  g.  the 
furuncle  in  diabetes,  the  suppurating  bubo  caused  by  a  chan- 
croid. The  location  of  the  local  sepsis  determines  to  a  cer- 
tain extent  the  therapeutic  indications. 

ABORTIVE  TREATMENT. — The  formation  of  an  acute  ab- 
scess is  always  preceded  by  local  inflammation.  If  the  seat 
of  inflammation  is  accessible,  e.  g.  in  the  extremities,  or 
comparatively  superficial,  heat  is  the  proper  agent  to  hasten 
pus-formation  or  to  abort  it  by  causing  absorption  of  the 
inflammatory  material.  The  small  dry-heat  cylinder,  the 
hot-immersion  bath,  the  hot  moist  pack,  the  Minin  light,  are 
serviceable  for  this  purpose.  If  the  seat  of  the  inflammation 
is  very  superficial,  the  positive  galvanic  pole  will  often  serve 
to  abort  suppuration,  e.  g.  in  furuncles.  If  heat  ceases  to 
give  relief  but  rather  increases  pain,  it  is  usually  a  sign  that 
suppuration  has  already  begun.  The  indications  during  the 
inflammatory  stage  are  discussed  under  the  head  of  IN- 
FLAMMATION (AcuTE)  and  FEVER.  The  impropriety  of  in- 
tensely cold  applications  to  comparatively  superficial  in- 
flammations is  referred  to  under  the  head  of  APPENDICITIS. 

POST-SURGICAL  TREATMENT. — After  an  abscess  has  been 


496  MODERN  PHYSIO-THERAPY. 

evacuated  by  incision,  the  rules  of  surgical  cleanliness 
should  prevail.  It  should  be  remembered  that  Finsen-rays 
or  sunlight  have  powerful  germicidal  and  restorative  prop- 
erties. 

TREATMENT  OF  CHRONIC  ABSCESSES. — The  contents  of  a 
chronic  abscess  gradually  lose  their  infective  character.  For 
this  reason  there  is  no  contra-indication  to  attempts  to  en- 
courage absorption  in  many  of  these  cases  (massage  of 
the  contiguous  tissues,  stimulating  hydro-therapeutic  ap- 
plications). If  the  abscess  is  open  and  directly  accessible, 
it  can  be  disinfected  with  chemical  rays  (sunlight,  arc- 
light).  To  start  reaction  pack  the  cavity  with  cotton, 
moisten  the  latter  thoroughly  by  allowing  it  to  absorb  water 
and  place  a  wet  negative  sponge  electrode  over  it,  positive 
pole  at  a  distance,  allowing  a  mild  galvanic  current  to  pass 
for  five  to  ten  minutes.  Remove  the  cotton  and  wash  out 
the  cavity.  If  the  cavity  oozes  or  bleeds,  pack  it  with  cot- 
ton, wet  the  cotton  as  before,  but  reverse  the  polarity,  using 
the  positive  pole  on  the  cavity.  A  high-frequency  appli- 
cation to  the  surrounding  part  promotes  absorption.  (See 
INFLAMMATION  (CHRONIC)  for  systemic  therapeutic  direc- 
tions.) Tubercular  abscesses  in  the  extremities  have  been 
successfully  treated  by  passive  congestion  (Bier's  stasis). 
Additional  information  under  ULCER. 

Sex-determination. — The  sex  of  an  unborn  child  is  not 
an  accidental  occurrence,  but  is  determined  by  factors  about 
which  but  little  is  known.  Many  observers  seem  to  think 
that  semen  which  has  had  time  to  mature  will  produce  boys. 
Men  who  are  temperate  in  their  sexual  life  are  more  likely 
to  have  male  offspring.  Women  who  are  in  the  open  air 
and  exposed  to  the  chemical  rays  of  the  sun  a  great  deal, 
are  more  likely  to  bear  male  children.  Parents  who  are 
strong  meat-eaters  are  not  likely  to  be  very  prolific.  They 
usually  have  but  few  children,  mostly  boys.  A  nitrogenous 
diet  during  pregnancy  is  supposed  to  favor  the  development 
of  boys.  (Darwin,  Brehm,  Finsen,  Schenck  and  others.) 
Conception  during  the  last  half  of  the  inter-menstrual  period 


THERAPEUTIC  INDEX.  497 

is  supposed  to  favor  male  offspring.  The  Mosaic  law  for- 
bade coitus  for  seven  days  after  menstruation.  This  seems 
to  explain  the  greater  proportion  of.  male  children  among 
the  Je\\s. 

Sexual  Weakness. — If  the  condition  is  a  part  of  a  gen- 
eral neurasthenia,  treat  the  latter.  (See  NEURASTHENIA, 
HYSTERIA,  FUNCTIONAL  DISORDERS.)  Suggestion  is  a  pow- 
erful therapeutic  agent.  Locally  the  ice-cold  catheter  (re- 
flux without  bladder-opening)  is  useful ;  also  steel  sound 
connected  with  weak  negative  galvanic  current,  positive  to 
the  back  or  feet.  Vibrate  perineum  and  lumbar  region,  cold 
douches  to  the  spine,  especially  lower  end.  Static  sparks  to 
perineum  and  spine.  Vacuum  treatment  of  penis,  followed 
by  faradization  of  the  organ.  Sexual  abstinence  must  be 
enjoined  in  every  case.  Average  duration  of  a  daily  elec- 
trical treatment  should  be  ten  to  fifteen  minutes. 

Singultus  (Hiccough). — Cold  douches  to  the  upper 
spine,  galvanization  or  faradization  of  the  phrenic  (side  of 
neck  below  ear  to  epigastrium),  vibration  over  epigastrium. 
Deep  inhalation  while  deep  pressure  over  epigastrium  is  be- 
ing made.  Forcible  dilatation  of  the  anal  sphincter  some- 
times interrupts  an  attack.  Faradism  (stomach  to  back) 
is  serviceable. 

Skin-diseases. — Disorders  of  the  cuticle  per  se  are  al- 
ways parasitic  in  character  (scabies,  pediculosis,  tinea  ton- 
surans,  sycosis,  tinea  circinata,  favus,  etc.).  In  these  dis- 
eases the  skin  itself  is  the  seat  of  the  disease-process  at- 
tributable to  a  specific  cause  which  is  located  in  and  active 
in  the  skin. 

Disorders  of  the  skin  which  represent  some  disturbance 
of  nutrition,  development  or  function  and  are  not  due  to  the 
presence  of  an  animal  or  vegetable  parasite  in  or  on  the 
cuticle,  are  always  symptomatic  of,  concomitant  with  or  con- 
sequential to  irritation  elsewhere.  'In  a  few  instances  this 
irritation  results  from  the  activity  of  external  causes  (the 
use  of  irritating  cosmetics,  soap,  wearing  apparel,  bedding 
and  the  lack  of  cleanliness).  In  the  vast  majority  of  in- 


498  MODERN  PHYSIO-THERAPY. 

stances,  however,  the  irritation  acts  from  within.  Some  nu- 
tritional (metabolic)  disorder  of  the  organism  or  some  part 
of  it  is  the  cause,  disease  of  the  skin  is  one  of  the  effects. 
The  skin  is  the  place  where  the  metabolic  disturbances  may 
explode.  The  physiological  importance  of  the  skin,  its  posi- 
tion anatomically  as  the  protective  cover  for  the  whole  body, 
its  importance  as  an  excreting  organ,  its  function  as  the  seat 
of  the  tactile  sense,  its  share  in  the  heat-control  of  the  or- 
ganism, its  close  relation  to  the  respiratory  function,  its  in- 
tricate structure,  all  these  factors  give  the  skin  a  position 
of  singular  prominence  in  the  economy.  It  is  not  surprising, 
therefore,  that  the  physiological  weal  and  woe  of  the  sys- 
tem or  any  part  of  it  should  find  sympathetic  and  symptom- 
atic expression  in  the  skin.  The  vast  majority  of  the  so- 
called  skin-diseases  are  not  disorders  of  the  cuticle  per  se, 
but  are  only  the  outward  showing  of  something  that  is 
wrong  within.  Under  this  head  are  included  all  the  ex- 
anthematous  manifestations,  the  different  forms  of  ery- 
thema, the  varieties  of  eczema,  the  disorders  of  the  sweat- 
glands,  of  the  tactile  corpuscles  (pruritus),  all  inflamma- 
tory and  catarrhal  affections  of  the  skin,  all  hypertrophies, 
pigmentations,  atrophies  and  new  formations  of  the  skin 
and  any  of  its  component  parts.  It  is  plain,  therefore,  that 
nearly  all  of  the  so-called  skin-diseases  are  merely  symp- 
tomatic. Local  treatment  is  frequently  futile.  Recurrences 
are  common.  The  reason  is  that  the  physician  has  treated 
a  symptom  and  not  the  condition  causing  it. 

PARASITIC  SKIN-DISEASES. — The  treatment  of  all  these 
true  diseases  of  the  cuticle  consists  in  the  destruction  of  the 
parasite  that  represents  the  true  cause  of  the  disorder.  If 
the  parasite  belongs  to  the  animal  kingdom  ( c.  g.  the  acarus 
scabiei,  the  pediculus)  it  should  be  poisoned  just  as  the 
larger  varieties  of  parasites,  e.  g.  roaches,  bedbugs,  rats,  etc., 
are  gotten  rid  of  by  poisoning.  Mercury,  sulphur  and  other 
chemicals  serve  an  excellent  purpose  as  parasiticides. 

If  the  parasite  is  an  anaerobic  organism  (<?.  g.  in  the  dif- 
ferent forms  of  tinea)  the  simplest  plan  of  attacking  it,  is  to 


THERAPEUTIC  INDEX.  499 

make  its  habitat  (skin)  uncomfortable  by  improving  the 
quantity  and  more  especially  the  quality  of  the  blood-supply 
of  the  skin.  Oxygen  is  the  parasiticide  par  excellence.  It 
should  be  carried  to  the  part  by  the  blood  and  by  the  air. 
To  keep  diseased  patches  of  skin  constantly  covered,  is, 
therefore,  manifestly  unhygienic.  The  very  fact  of  a  veg- 
etable growth  developing  in  the  skin,  proves  the  lowered 
vitality  of  the  latter.  This  is  seen  in  cases  of  diabetes  where, 
as  a  result  of  the  suboxidation  of  the  whole  system,  the 
skin  is  in  poor  condition  and  furnishes  a  splendid  soil  for 
the  growth  of  pus-germs  (furuncles).  The  same  may  be 
said  of  pustular  acne,  which  is  always  associated  with  dis- 
turbed states  of  general  nutrition.  In  all  these  and  similar 
conditions  the  first  duty  of  the  dermatologist  is  to  regulate 
the  organism  at  large  in  keeping  with  the  general  laws  of 
physiology  and  hygiene.  (See  chapter  on  PERSONAL  HY- 
GIENE.) 

The  local  treatment  of  these  skin-lesions  due  to  vegetable 
parasites  should  consist  in  the  application  of  such  agents  as 
impair  and  suspend  the  vitality  of  these  germs.  Sunlight, 
,Finsen-rays,  X-rays  and  high-frequency  currents  have  a 
directly  germicidal  effect  and  are,  therefore,  applicable  in 
all  these  conditions.  The  rationale  of  these  agents  and  the 
technique  in  applying  them  are  discussed  in  several  chapters 
in  the  first  part  of  this  book.  A  classical  example  of  this 
form  of  medication  is  Finsen's  application  of  concentrated 
chemical  rays  in  cases  of  lupus  vulgaris. 

NON-PARASITIC  SKIN-DISEASES. — These  disorders  are  all 
symptomatic.  To  understand  the  physiology  of  nutrition 
under  altered  conditions  of  metabolism  and  the  effects  of 
such  alterations,  see  FUNCTIONAL  DISORDERS,  REFLEX  DIS- 
ORDERS, DYSPEPSIA,  CONSTIPATION,  SYPHILIS,  and  the  chap- 
ters on  PERSONAL  HYGIENE  and  DIETETICS.  From  this 
strictly  physiological  point  of  view  there  is  no  scientific  place 
for  dermatology  as  a  regional  specialty.  The  symptomatic 
character  of  skin-diseases  is  well  illustrated  in  the  herpes 
labialis  of  acute  fevers,  the  acne  of  puberty  and  pelvic  dis- 


500  MODERN  PHYSIO-THERAPY. 

orders,  the  urticaria  of  dietetic  errors,  the  pig-mentations  of 
pregnancy,  the  eruptions  of  syphilis,  etc.,  etc. 

In  attempting  to  treat  any  case  of  non-parasitic  skin- 
disease,  identify  the  etiological  factor,  if  such  is  possible. 
If  the  identity  of  the  cause  is  not  quite  plain,  generalize  your 
efforts  by  bringing  the  organism  as  near  the  physiological 
criterion  of  perfection  as  possible.  Regulate  all  its  func- 
tions, remove  nutritional  disorders  and  correct  the  habits 
and  the  surroundings  of  the  patient.  The  dietetic  habits  of 
the  patient  are  of  the  utmost  importance.  Spices,  salt,  pep- 
per, vinegar,  nutmeg,  olives  and  similar  substances  are  not 
infrequently  the  cause  of  pimples,  eczema  and  other  skin- 
troubles  so  annoying  to  the  young  woman  whose  happiness 
would  be  complete  if  it  were  not  for  those  terrible  pimples, 
facial  blemishes,  etc.  These  patients  go  from  one  derma- 
tologist to  another,  take  one  quack-medicine  after  another 
and  become  disgusted  with  medicines  and  medical  men. 
Schroth  treated  all  skin-diseases  dietetically  and  hygien- 
ically  and  cured  the  chronics  who  had  run  the  gauntlet  of 
skin-specialists  and  skin-clinics.  The  one  great  fundamental 
law  in  the  treatment  of  non-parasitic  skin-diseases  is :  Treat 
the  whole  patient  principally  and  the  affected  skin  inci- 
dentally ! 

The  local  treatment  is  suggested  by  the  special  features 
which  the  individual  case  presents.  In  syphilitic  cases  local 
treatment  of  the  manifestations  is  unnecessary  and  even 
harmful.  (See  SYPHILIS.)  Having  ruled  out  the  causative 
activity  of  external  agencies  (soap,  cosmetics,  filth,  irritat- 
ing clothing  or  bedding,  etc.),  examine  into  the  changes 
which  the  skin  is  undergoing  or  has  undergone  (destruc- 
tion or  loss  of  tissue,  inflammatory  reaction,  catarrhal  con- 
dition, hypertrophic  changes,  atrophy,  malnutrition,  new 
formations,  etc.,  etc.).  Notice  functional  disorders  (sensa- 
tion, secretion).  If  there  is  an  actual  destruction  or  loss  of 
tissue,  apply  the  principles  given  under  the  head  of  ULCER. 
If  there  is  hyper-nutrition,  adopt  antiphlogistic  measures. 
If  nutrition  is  sluggish,  stimulate.  If  there  is  new  devel- 


THERAPEUTIC  INDEX.  501 

opment,  destroy  it  and  create  a  healthy  surface  or  bring 
about  a  natural  reaction  (absorptive  process,  retrograde 
metamorphosis).  Act  upon  the  affected  area  through  the 
blood-vessels  and  lymphatics  of  the  surrounding  tissues  by 
heat,  negative  electric  modalities,  vibration,  centrifugal  mas- 
sage, etc.,  if  you  wish  to  stimulate ;  or  by  cold,  positive  cur- 
rents, centripetal  massage,  if  you  desire  to  depress  local 
reaction.  Priessnitz  cured  a  case  of  eczema  rubrum  of  the 
foot  by  cold  applications  to  the  whole  thigh.  I  know  of  a 
case  of  dry  eczema  of  the  hand  which  was  cured  by  a  mas- 
seur who  confined  his  manipulations  to  the  arm.  Vibration 
of  the  neighboring  lymphatics  frequently  starts  a  powerful 
reaction  in  an  affected  patch  of  skin.  The  Minin  light 
causes  intense  hyperemia  of  the  superficial  parts  and  is  in- 
dicated in  the  treatment  of  skin-troubles  caused  by  and  as- 
sociated with  local  malnutrition. 

The  following  list  of  the  more  common  afflictions  of  the 
skin  with  therapeutic  suggestions  as  to  local  treatment  will 
be  found  convenient  for  ready  reference,  the  therapeutic 
agents  being  named  in  the  order  of  their  efficiency : 

Acne  rosacca. — X-rays.  Finsen-rays.  Negative  elec- 
trolysis for  destruction  of  connective  tissue.  Positive  elec- 
trolysis for  vascular  nodules. 

Acne  z'ulgaris. — X-rays.  Finsen-rays.  High-frequency. 
Minin  rays.  Positive  electrolysis. 

Comedo. — Negative  electrolysis.     Minin  rays. 

Eczema  (chronic). — High-frequency.  Negative  static 
spray.  X-rays.  Galvanism. 

Herpes. — High-frequency.    Positive  static  spray. 

Hypertrichosis. — Negative  electrolysis  by  means  of 
needle. 

Keloid. — Negative  electrolysis. 

Keratosis  scnilis. — Remove  by  knife  and  X-ray  the  base. 

Lichen  pi  anus. — High-frequency.     Static  spray. 

Lupus  erytheniatosus. — High-frequency.  Piffard  rays. 
Finsen  rays.  X-rays.  Minin  rays. 


502  MODERN  PHYSIO-THERAPY. 

Lupus  vulgar  is, — Finsen  rays.  X-rays.  Cupric  elec- 
trolysis. High-frequency. 

Pruritus. — Static  spray.  High-frequency.  Positive  gal- 
vanic application.  X-rays. 

Psoriasis. — High-frequency.  Finsen  rays.  Cupric  elec- 
trolysis. X-rays. 

Scleroderma  pigmentosum. — High-frequency.    X-rays. 

Sycosis, — Finsen  rays.     X-rays.     High-frequency. 

Tinea  circinala. — X-rays.  Finsen-rays.  High-fre- 
quency. Negative  static  spray.  Cupric  electrolysis. 

Spasm. — Heat  (bath,  hot  pack,  Minin  light)  is  the  most 
useful  anti-spasmodic.  If  the  extremities  are  attacked,  a 
tight  bandage  above  the  contraction  will  be  effective.  Local 
mild  faradization  is  useful.  Alternate  thermic  shocks  (hot 
and  cold  douches)  are  frequently  effective.  All  anodynes 
have  an  anti-spasmodic  effect.  (See  PAIN.)  Spasm  may 
be  symptomatic.  (See  FUNCTIONAL  DISORDERS  and  AUTO- 
INTOXICATION.) 

Sprains. — Sudden  injury  to  the  soft  tissues  surrounding 
a  joint  due  to  a  twisting  or  wrenching  of  the  latter  is  at- 
tended by  a  severe  reaction,  pain,  swelling,  impairment  of 
motion.  Recovery  after  sprains  is  usually  slow  and  not  in- 
frequently incomplete  unless  means  are  adopted  to  cause 
rapid  absorption  of  the  swelling  and  to  restore  the  part 
functionally.  F,xperience  has  shown  that  the  application  of 
intense  dry  heat  (baking  in  a  thermic  cylinder  of  suitable 
size)  is  the  proper  therapeutic  method  to  insure  a  quick 
result  in  these  cases.  The  pain  is  promptly  relieved  and  the 
process  of  repair  inaugurated,  leading  to  a  good  result  in  a 
few  days.  The  treatment  should  be  given  every  day  for  one 
hour  with  a  temperature  of  not  less  than  300°  F.  In  severe 
cases  two  treatments  daily  might  be  required.  After  the 
treatment  the  patient  should  rest  for  an  hour  and  then  re- 
ceive gentle  centripetal  massage.  To  accentuate  the  local 
reparative  effort,  alternate  applications  of  hot  and  cold 
water  should  be  given  once  or  twice  daily  and  these  again 


THERAPEUTIC  INDEX.  503 

followed  by  massage.  The  indirect  negative  static  spray  is 
useful  as  an  adjunct  in  the  treatment.  A  mild  galvanic  cur- 
rent with  the  positive  pole  near  the  point  of  greatest  swelling 
and  pain  might  be  advantageously  used  for  ten  minutes 
every  day.  The  local  electric-light  bath  and  the  use  of  the 
Minin  apparatus  have  been  found  serviceable  as  substitutes 
for  the  dry-heat  cylinder,  although  the  latter  is  undoubtedly 
more  uniformly  effective.  The  heat-treatment  can  be  en- 
hanced by  local  sun-baths  given  in  the  interval  between  the 
treatments.  In  chronic  or  neglected  acute  cases  the  regime 
is  practically  the  same  as  in  the  acute  variety.  Vibration, 
stimulation  and  static  sparks  are  useful  unless  pain  interdicts 
their  employment.  Active  and  passive  movements  can  be 
practiced.  The  old  way  of  resting  and  immobilizing  the 
affected  part  has  justly  become  obsolete.  Bier's  stasis  might 
be  used  in  old  painful  cases.  Massage  should  be  added. 

Stenosis. — The  narrowing  of  any  canal  (e.  g.  the  cerv- 
ical canal),  if  it  is  due  to  changes  (e.  g.  cicatrization)  in  the 
walls  of  the  canal  itself  is  best  treated  by  negative  electroly- 
sis. The  technique  is  analogous  to  that  given  for  the  elec- 
trolytic treatment  of  urethral  structures.  (See  NEGATIVE 
ELECTROLYSIS,  Part  I  of  book.)  The  current  strength  and 
duration  and  frequency  of  treatments  must  be  adapted  to 
the  conditions  found. 

Stiff  Joints. — (See  RHEUMATISM  and  RHEUMATOID 
ARTHRITIS.)  Therapy  consists  in  local  dry-heat  treat- 
ment, massage,  passive  movements,  vibration,  oscillation, 
static  spray  or  sparks.  If  ligaments  are  contractured,  cure 
is  doubtful.  If  stiffness  is  due  to  disuse,  local  malnutrition, 
inflammatory  exudates,  adhesions,  treatment  should  be  per- 
sisted in. 

Stricture. — The  treatment  of  the  structural  narrowing 
of  any  canal  is  by  negative  electrolysis  (negative  pole  of  a 
galvanic  current  in  the  strictured  canal,  positive  pole  on  the 
outer  skin  near  by),  the  character  of  the  stricture  and  of 
the  canal  determining  the  size  and  kind  of  electrode,  the 
frequency  and  duration  of  treatments  and  the  strength  of 


504  MODERN  PIIYSIU-TIIKRAPY. 

current.  The  technique  is  a  suitable  modification  of  \e\v- 
man's  method  described  in  the  chapter  on  Tine  TIIKRA- 
PEUTIC  Uses  OF  ELECTRIC  CURRENTS.  Put  suitable  electrode 
in  place,  turn  on  current  slowly,  bear  down  on  electrode 
gently  until  the  instrument  passes  through  the  constricted 
portion  twice,  turn  current  off  slowly,  remove  electrode. 
Average  duration  of  treatment  is  five  to  ten  minutes,  aver- 
age strength  of  current  is  five  milliamperes.  Repeat  elec- 
trolysis every  four  days  with  a  slightly  larger  electrode  un- 
til stricture  is  removed.  Be  sure  to  get  the  right  kind  and 
size  of  electrode.  This  method  is  applicable  in  cicatricial 
strictures  of  the  male  or  female  urethra,  of  the  Eustachian 
tube,  the  lachrymal  canal,  the  oesophagus,  the  cervix,  the 
uterus,  the  rectum  and  the  nares.  Cleanliness  is  of  the  great- 
est importance. 

Strictures  of  the  Male  Urethra. — -Negative  electrolysis 
(See  Part  I  of  book). 

Sunstroke. — The  majority  of  cases  of  insolation  are 
cases  of  heat-exhaustion.  This  condition  is  brought  on  by 
exposure  to  excessive  (solar  or  artificial)  heat  and  is  char- 
acterized by  great  depression  of  all  the  important  functions 
of  the  organism.  There  are  some  lowering  or  elevation  of 
normal  temperature,  weak  and  rapid  pulse,  quickened 
breathing,  pallid  and  cold  face,  partial  or  total  loss  of  con- 
sciousness. The  patient  may  suddenly  feel  ill,  be  seized  with 
convulsions  or  tremors  and  fall  unconscious,  rapidly  de- 
veloping the  symptoms  named  above.  Very  few  cases  are 
true  cases  of  meningitis  or  of  acute  sunstroke.  The  latter 
condition  is  marked  by  its  sudden  onset,  coma,  delirium, 
convulsions,  paralysis,  labored  respiration,  rapid  pulse  and, 
above  all,  a  rise  of  temperature  up  to  110°  F.  and  even 
higher.  All  metabolic  function  ceases,  the  albumen  of  the 
blood  coagulates  and  the  patient  dies.  These  cases  are  rare. 
Nine  out  of  ten  heat  victims  that  are  picked  up  on  the  streets 
during  the  summer  months  and  carried  to  the  hospital  are 
sufferers  from  heat-exhaustion  (heat-prostration)  and  not 
sunstroke.  This  is  shown  by  the  large  number  of  recoveries. 


THERAPEUTIC  INDEX.  505 

Recovery  is  the  rule  in  heat-exhaustion,  while  it  is  the  ex- 
ception in  sunstroke. 

The  treatment  of  heat-exhaustion  is  suggested  by  the 
physiological  laws  that  underlie  the  heat-regulation  in  the 
organism.  There  is  a  temporary  impairment  of  the  vegeta- 
tive functions.  The  machinery  of  metabolism  is  working 
under  lower  pressure,  excretion — for  the  moment — is  at  a 
comparative  standstill,  toxines  are  taken  up  into  the  blood. 
The  object  of  the  physiological  treatment  is  to  give  the  or- 
ganism a  chance  to  get  rid  of  the  accumulating  heat  and 
products  of  oxidation.  The  skin  must  be  stimulated'.  In 
this  way  the  radiation  of  stored-up  heat-energy  is  facilitated 
and  excretion  started.  Massage  and  any  kind  of  moist  or 
dry,  warm  or  hot  application  over  the  general  body-surface 
are  the  proper  agents  for  this  purpose.  The  patient  can'  be 
treated  in  the  dry-heat  cylinder,  the  electric-light  bath,  a 
warm  bath  or  by  means  of  moist  or  dry  packs.  Friction  of 
the  skin  should  be  added.  Diaphoresis  must  be  enforced  at 
all  hazards. 

The  employment  of  ice-cold  water  or  even  ice-applica- 
tions in  the 'treatment  of  these  cases  is  contrary  to  all  laws 
of  physiology  and  lessens  the  chances  of  recovery  by  closing 
the  pores  of  the  skin  and  thus  blocking  the  avenues  of  ex- 
cretion and  elimination.  If  patients  recover  under  these 
circumstances,  it  is  not  because  of  the  treatment  but  in  spite 
of  the  treatment.  This  statement  is  made  with  all  possible 
i  mphasis  in  view  of  the  treatment  which  is  en  vogue  in 
many  of  the  public  hospitals  where  to  the  danger  of  heat- 
prostration  are  added  the  equally  great  dangers  of  an  un- 
scientific and  inhumane  therapy. 

In  addition  to  the  application  of  external  heat,  warm 
drinks  and  stimulants  should  be  administered.  The  colon 
should  be  irrigated  and  the  patient  given  the  benefits  of  the 
best  hygienic  surroundings.  The  head  should  be  kept  low 
and  cool.  After  diaphoresis  has  been  started,  the  patiertt 
can  be  stimulated  by  faradism  or  galvanism  (bath  or  appli- 
cation to  the  spine). 


506  MODERN  PHYSIO-THKKAPY. 

Heat-prostration,  heat-exhaustion  and  sunstroke  (inso- 
lation) represent  different  degrees  of  the  same  affliction. 
True  sunstroke  is  comparatively  rare.  It  is  characterized 
by  its  tempestuous  onset  and  by  the  high  temperature  which 
ranges  from  100°  to  110°  F.  The  heat-centers  as  well  as 
the  centers  of  respiration  and  circulation  are  overstimulated 
until  they  are  exhausted  and  paralyzed.  Immersing  the  pa- 
tient in  ice-water  is  supposed  to  reduce  the  temperature 
which  threatens  to  disorganize  the  tissues.  It  is  doubtful 
whether  the  chilling  of  the  body-surface  and  the  complete 
suspension  of  skin-function  are  physiologically  indicated. 
Vigorously  rubbing  the  patient  with  ice  and  douching  the 
spine  with  cold  water  are  undoubtedly  the  better  methods 
because  they  antagonize  the  hyperpyrexia  and  at  the  same 
time  whip  up  the  lagging  vital  powers  in  a  most  pronounced 
manner.  This  is  apparent  in  the  changes  which  take  place 
in  the  respiratory  movements  and  in  the  circulation.  The 
temperature  drops  and  the  regime  indicated  in  the  treatment 
of  heat-prostration  should  be  instituted.  At  all  events,  sun- 
stroke in  its  pronounced  severe  form  is  rare.  The  prognosis 
is  usually  unfavorable.  In  arriving  at  a  diagnostic  conclu- 
sion concerning  the  various  degrees  of  heat-prostration,  the 
thermometer  in  the  rectum  should  determine  the  exact  grade 
of  severity.  The  more  tempestuous  the  onset,  the  graver  the 
condition  of  the  patient.  Respiration  is  usually  quick  and 
superficial  in  mild  cases,  stertorous  and  labored  in  the 
severer  cases  although  this  is  not  an  invariable  rule.  Lost 
reflexes  and  complete  muscular  relaxation  are  bad  signs. 

Superfluous  Hairs. — Negative  electrolysis  (see  Part  I 
of  the  book),  X-ray  exposures  produce  a  temporary  effect. 

Syphilis. — Lues  is  a  toxemia  of  long  duration  and  varia- 
ble symptomatology.  Three  distinct  stages  are  recognized, 
to  wit:  the  primary  (hard  chancre,  initial  lesion),  the  sec- 
ondary (eruptions,  throat-symptoms,  etc.),  the  tertiary 
(lesions  of  bones,  nerves  and  organs  of  special  sense).  The 
tertiary  stage  is  seen  in  unusually  severe  cases  of  syphilis 
and  in  cases  that  have  undergone  the  wrong  kind  of  thera- 


THERAPEUTIC  INDEX.  507 

peutic  regime.  The  virus  of  syphilis  through  ages  and  gen- 
erations of  inoculation  and  through  more  perfect  hygienic 
surroundings  and  habits-  of  people,  has  become  very  much 
attenuated.  It  is  comparatively  rare  to  see  a  severe  case  of 
syphilis  nowadays.  Syphilitic  patients,  as  a  rule,  suffer 
more  from  mercurialization  than  from  the  disease  in  the 
treatment  of  which  mercury  is  supposed  to  be  the  specific 
remedy. 

The  rational  therapy  of  syphilis  was  first  taught  and  con- 
sistently practiced  by  Johann  Schroth.  It  is  the  elaboration 
of  the  principle  that  the  innate  restorative  power  of  the  or- 
ganism (vis  medic  atrix  nature)  is  amply  able  to  take  care 
of  the  body  if  given  the  proper  chance.  Nature  absorbs  and 
eliminates  the  syphilitic  toxines,  unless  the  organs  of  ab- 
sorption and  elimination  are  unable  to  do  the  work.  The 
objects  of  treatment,  therefore,  are — (i)  to  keep  the  glands 
in  as  active  a  condition  as  possible,  (2)  to  preserve  the  func- 
tional integrity  of  the  eliminative  organs  (emunctories),  and 
(3)  to  improve  the  resisting  power  of  the  whole  system. 
The  therapy  practiced  by  Schroth  aims  at  the  accomplish- 
ment of  this  triple  object.  The  enormous  experience  which 
Schroth  and  his  pupils  gathered  in  the  treatment  of  syphilis 
has  never  been  equaled  by  any  man  or  any  school. 

As  soon  as  the  existence  of  syphilis  has  been  ascertained, 
the  patient  is  subjected  to  a  dietetic  regime  by  which  the 
system  is  compelled  to  accelerate  the  metabolic  changes. 
The  amount  of  liquids  consumed  is  gradually  lessened.  The 
patient  is  put  on  dry  carbo-hydrate  diet,  consisting  prin- 
cipally of  stale  bread,  rice  and  some  fresh  fruit.  Every 
other  day  a  glass  of  cider  is  allowed.  Milk,  coffee,  tea  and 
beer  are  absolutely  excluded.  It  is  understood  that  a  rigor- 
ous dietetic  regime  of  this  kind  can  not  be  instituted  ab- 
ruptly. Two  weeks  or  more  are  consumed  in  paving  the 
way  for  this  diet  which  should  be  consistently  followed  out 
for  fully  two  weeks,  when  the  patient  is  again  allowed  to 
slowly  and  gradually  return  to  a  more  liberal  diet.  The 
effect  of  this  dry  diet  (Trockenkur)  is  a  veritable  revolution 


508  MODERN  PHYSIO-THERAPY. 

in  the  metabolic  functions  of  the  organism.  Oxidation,  in 
this  case  properly  called  self-consumption  of  the  organism, 
becomes  so  intense  that  the  temperature  rises  two  and  even 
more  degrees  above  the  normal.  The  system  is  literally 
devouring  itself. 

The  effect  of  this  self-consumption  is  accentuated  by 
stimulation  of  the  emunctories.  The  vapor-bath  or  the  dry- 
heat  cylinder  is  called  into  requisition  twice  a  week  to  open 
up  the  pores  of  the  skin  and  help  in  the  process  of  forcible 
dehydration.  The  colon  is  irrigated  every  day  or  two.  In 
addition  to  all  this  the  patient  is  given  the  advantages  of 
perfect  hygienic  surroundings,  fresh  air,  sunlight,  freedom 
from  care  and  the  suggestive  influence  of  the  physician's 
hopefulness.  The  external  evidences  of  syphilis  are  in  no 
way  interfered  with.  The  syphilitic  lesions  of  the  skin  and 
the  plaques  on  the  mucous  surfaces  are  distinctly  efforts  of 
nature  to  eliminate  toxic  material  and  should,  therefore,  not 
be  interfered  with.  Absolute  and  painstaking  cleanliness 
should  be  the  only  agent  used  in  their  treatment.  Use  water 
as  a  mouth-wash  and  as  a  general  cleansing  agent  and  some 
bland  powder  (rice-powder)  as  a  dressing  on  skin-lesions, 
if  they  should  require  a  dressing.  Schroth  never  inter- 
fered with  discharges  of  any  kind.  He  looked  upon  them 
as  being  eliminative  and,  therefore,  salutary.  In  his  elimina- 
tive  efforts  lie  used  great  caution  born  of  experience.  He 
reasoned  that  too  forcible  elimination  would  result  in 
fatigue  and  eventual  exhaustion  of  the  eliminating  organs 
(glands).  After  six  weeks  of  dry  diet  and  eliminative 
procedures  Schroth  allowed  his  patients  a  liberal  non-stimu- 
lating diet  (mostly  fruit  and  vegetables),  but  no  alcoholic 
drink  except  cider.  A  sweat-bath  every  three  or  four  days, 
open  bowels  twice  a  day,  and  otherwise  perfect  hygiene  were 
the  features  of  the  after-treatment.  The  patient  whose 
weight  went  down  considerably  during  the  six  weeks  of 
active  treatment,  soon  regained  his  former  weight.  In  some 
cases  another  "Trockenkur"  was  given  after  two  or  three 
months. 


THERAPEUTIC  INDEX.  509 

These  are  the  gross  features  of  Schroth's  method.  It  is 
nnnecessary  to  say  that  it  is  a  most  severe  ordeal  for  the 
patient  .while  its  rationale  and  its  results  are  unquestioned. 
The  sensation  of  thirst  becomes  an  unbearable  torment  and 
requires  unusual  will-power  and  endurance  on  the  part  of 
the  patient.  A  milder  regime  patterned  after  Schroth  will 
have  to  be  adopted  in  most  cases.  If  it  is  too  mild,  it  is 
worthless.  The  results  under  Schroth's  treatment  were  so 
uniformly  good  and  so  surprisingly  prompt  that  his  con- 
temporaries at  the  University  of  Vienna  could  not  help  ad- 
mitting the  value  of  dietetic  directions  in  the  treatment  of 
syphilis.  Schroth  persistently  refused  to  treat  any  one  who 
had  had  mercurial  treatment.  "Mercury  has  a  selective  ac- 
tion on  the  glandular  system  or  rather  on  the  trophic  nerves 
which  control  the  functional  activity  of  the  glands,  especially 
those  of  the  salivary  and  pancreatic  glands.  In  very  small 
doses  it  stimulates  the  action  of  the  glands."  If  continued, 
the  parotid  glands  and-the  pancreas  soon  show  the  effect  of 
overstimulation  while  the  glandular  system  at  large  merges 
into  a  condition  of  lethargy.  It  is  very  difficult  to  make  a 
mercurialized  patient  sweat.  Such  a  person  suffers  a  great 
deal  from  the  cold  in  the  winter,  always  has  cold  skin  and 
especially  dry,  cold  hands,  and  presents  in  his  whole  physical 
make-up  the  evidences  of  seriously  impaired  metabolism. 
For  this  reason  Schroth  objected  to  applying  his  method  to 
persons  who  had  taken  mercury. 

The  results  of  mercurial  treatment  are  neither  uniform 
nor  are  they  always  favorable.  The  disappearance  of 
syphilitic  manifestations  after  mercury  is  easily  accounted 
for  by  remembering  the  inhibitory  effect  of  mercury  on 
glands  generally  and  the  resulting  impairment  of  metabol- 
ism. The  cases  drag  along  for  years  and  suffer  more  from 
the  damage  done  by  the  treatment  than  by  the  disease.  After 
a  variable  length  of  time  the  glandular  function  reasserts 
itself  and  an  unexpected  manifestation  of  an  old  syphilis  is 
the  result.  This  is  notoriously  the  case  in  mercurialized 
patients.  The  stubbornness  of  syphilitic  glands  in  mer- 


510  MODERN  PHYSIO-THERAPY. 

curialized  patients  is  in  strange  contrast  to  the  statement 
made  by  Schroth  that  enlarged  glands  in  syphilis  are  the 
exception  rather  than  the  rule.  Fortunately  the  belief  in 
the  specific  action  of  mercury  in  syphilis  is  not  by  any 
means  as  general  as  it  was  twenty-five  years  ago.  Under 
dietetic  regime  the  manifestations  of  syphilis  are  quicker  to 
appear,  more  pronounced  and  more  prompt  to  disappear 
permanently. 

The  treatment  of  a  fresh  case  of  syphilis  should  be  begun 
as  soon  as  the  diagnosis  has  been  definitely  made.  A  mild 
dietetic  regime,  patterned  after  Schroth,  should  be  in- 
stituted. The  dry-heat  cylinder  should  be  used  every  four 
days.  Irrigation  of  the  colon  should  be  practiced  daily.  The 
patient  should  have  perfect  hygienic  advantages  and  be 
taught  to  be  absolutely  clean.  Therapeutic  measures  to  im- 
prove the  general  health  (general  high-frequency  treat- 
ments, static  spray,  vibration  along  the  spine,  cold  douches) 
are  very  useful.  In  a  series  of  twelve  cases  of  acquired 
syphilis  I  have  seen  eleven  perfect  recoveries.  One  case 
acted  badly  and  seemingly  went  from  bad  to  worse  until  he 
finally  passed  from  my  notice.  He  came  to  me  from  a 
Western  health  resort  which  is  a  Mecca  of  people  who 
worshiped  well  but  not  wisely  at  the  shrine  of  some  infected 
Venus.  The  man  had  had  the  stereotyped  inunction-treat- 
ment and  had  improved  while  under  mercurial  treatment, 
at  least  as  far  as  the  outward  signs  of  the  disease  were  con- 
cerned. This  is  usually  the  case  on  account  of  the  effects  of 
mercury  noted  above.  One  of  the  cured  cases  I  treated  in 
1898  in  strict  accordance  with  Schroth's  plan.  The  man 
had  a  typical  case.  After  six  months  he  passed  from  notice. 
In  1903  he  reappeared  only  to  show  what  a  magnificent 
specimen  of  physical  manhood  he  was.  He  had  married  in 
1899.  His  wife  gave  birth  to  two  healthy  children. 

There  is  no  doubt  in  my  mind  that  the  action  of  mercury 
in  syphilis  is  simply  a  matter  of  faith  and  habit,  not  of  con- 
viction, with  most  physicians.  It  is  the  ex  cathedra  teach- 
ing of  a  few  eminent  syphilographers.  The  average  phy- 


THERAPEUTIC  INDEX.  511 

sician  does  not  see  enough  of  syphilis  to  be  able  to  judge  for 
himself.  If  he  did,  he  would  soon  realize  that  most  syph- 
ilitics  recover  in  spite  of  mercurial  treatment  and  not  on 
account  of  it.  The  healing  power  of  nature  is  equal  to  the 
double  task  of  fighting  the  ravages  of  treatment  and  dis- 
ease. There  is  less  objection  to  potassium  iodide  on  this 
score.  However,  it  impairs  digestion  and  produces  accumu- 
lative effects.  The  latter  should  be  remembered  in  giving 
dry-heat  treatments.  If  a  patient  has  taken  K  I  for  a  few 
days,  one  thermic  treatment  at  times  is  capable  of  causing 
acute  iodism.  In  conclusion  I  wish  to  state  that  the  initial 
lesion  of  syphilis  reacts  favorably  upon  the  concentrated 
chemical  rays.  The  application  should  be  made  daily  and 
be  followed  by  a  Minin  exposure.  The  treatment  of  bubo 
does  not  differ  from  that  in  any  other  kind  of  localized 
glandular  inflammation.  The  syphilitic  bubo  but  rarely 
suppurates,  while  the  chancroidal  bubo  usually  does. 

Tetanus. — Hauffle  reports  a  case  of  traumatic  tetanus 
which  was  cured  by  dry-heat  baths,  general  packs  and  sun- 
baths. 

Therapy  of  Rest  and  Recreation. — The  principles  of 
this  most  important  form  of  physio-therapeutic  medication 
are  indicated  in  the  chapter  on  PERSONAL  HYGIENE  and 
elsewhere.  Rest  is  to  counterbalance  work,  using  both 
terms  in  a  physiological  sense.  Recreation  equalizes  the 
output  of  energy  by  exercising  physical  or  mental  forces 
that  have  been  unengaged  while  other  physical  or  mental 
energies  have  been  at  work.  Rest  means  the  absence  of  ef- 
fort, recreation  is  a  change  of  effort.  Both  meet  vital  re- 
quirements of  the  organism  and  have,  therefore,  a  deep 
therapeutic  significance.  Their  application  in  the  treatment 
of  diseased  conditions  offers  a  vast  field  for  physiological 
and  psychological  reasoning. 

There  is  no  difficulty  in  understanding  the  meaning  and 
purpose  of  rest,  because  the  significance  of  work,  physical 
(muscular,  mental)  and  physiological  (organic,  functional), 
is  plain.  Recreation  as  a  therapeutic  factor  is  not  so  easily 


512  MODERN    I'IIYSIO-TIIKKAI-Y. 

interpreted  and  made  subservient  to  a  therapeutic  purpose. 
Practical  methods  by  which  suitable  recreations  are  to  be 
selected  to  meet  the  requirements  of  special  conditions,  ac- 
cording to  \V.  J.  Herdman,  vary  as  taste,  occupations  and 
opportunities  vary.  From  the  complexity  of  occupations  in 
which  people  engage  there  results  the  greatest  variety  of 
channels  through  which  the  store  of  nervous  energy  is  de- 
picted. Outdoor  plays  and  games,  requiring  some  skill, 
such  as  boating,  fishing,  swimming,  skating,  horseback  rid- 
ing, gardening,  tool  work,  and  the  like,  are  of  much  more 
recreative  value  than  any  of  the  artificial  gymnastics  which 
have  no  purpose  nor  incentive  beyond  the  movement  itself. 
For  the  brain  worker  the  way  is  open  to  innumerable  recrea- 
tions, and  the  opportunity  for  choice  and  the  possibility  of 
varying  their  character  at  will,  make  the  problem  of  health- 
ful living  an  easy  one  if  any  man  would  but  cultivate  a 
sufficient  variety  of  interests,  so  that  when  one  channel  of 
activity  was  for  any  reason  closed  to  him,  as  a  relief  from 
necessary  work,  he  had  but  to  choose  another.  The  practi- 
cal result  in  this  is  seen  when  the  statistics  of  health  and 
longevity  of  the  brain  worker  and  of  the  muscle  worker  are 
compared.  The  researches  of  Beard  and  others  had  shown 
that  brain  workers  not  only  lived  from  fourteen  to  twenty 
years  longer  than  muscle  workers,  but  that  their  health  was 
more  uniformly  good  and  their  stature  of  larger  average. 
When  mankind  is  once  emancipated  from  the  conception 
that  honest  work  is  contemptible  drudgery,  and  learns  to 
recognize  the  pleasures  and  recompense  it  has  in  store 
when  rightly  apprehended,  which  means  that  the  work  se- 
lected must  be  suited  to  individual  capacities  and  tastes,  and 
when  greed  and  selfishness  give  place  to  a  spirit  of  mutual 
helpfulness,  the  problem  of  recreation — from  a  social, 
economic,  sanitary  and  therapeutic  point  of  view — will  be 
solved.  ( Herdman. ) 

Some  authors  consider  the  primary  and  predominant 
factor  in  practically  all  forms  of  recreation  the  psychic  one. 
Although  the  influences  of  the  mind  over  the  body  are 


THERAPEUTIC  INDEX.  513 

recognized  in  a  general  way,  they  are  fully  comprehended  by 
comparatively  few.  The  sudden  change  from  a  state  of 
extreme  depression  and  misery,  with  perfectly  distinct  phys- 
ical suffering,  to  one  of  buoyancy  and  exultation,  with  en- 
tire forgetfulness  of  self  as  a  result  of  a  change  of  emotion, 
is  a  not  unfamiliar  experience  in  the  lives  of  most  people. 
As  an  illustration  of  the  broad  effects  of  mental  impression 
in  general,  G.  W.  McCaskey  mentioned  the  case  of  an  at- 
torney under  his  observation,  whose  digestion  after  con- 
siderable improvement  remained  more  or  less  distressing  in 
spite  of  all  he  could  do  for  his  relief,  which  included  the 
treatment  of  a  local  stomach  disease  by  suitable  methods, 
careful  regulation  of  diet,  gymnastics,  and  a  liberal  amount 
of  outdoor  exercise.  This  gentleman  would  go  to  a  little 
lake  fort\'  miles  away,  and  the  very  first  meal  that  he  would 
cat  there,  long  before  there  could  be  any  possible  effect  of 
exercise,  atmospheric  change,  etc.,  would  be  digested  with- 
out the  slightest  disturbance  or  even  consciousness  on  his 
part,  and  this  would  continue  until  his  return  to  the  city, 
when  the  old  conditions  would  be  immediately  resumed. 
If  the  various  forms  of  recreation  were  closely  scrutinized, 
it  would  probably  be  found  that  those  diversions  and 
amusements  which  produced  the  promptest  and  most  bril- 
liant effects  upon  both  the  mental  and  physical  states  of 
those  who  participated  were  precisely  those  in  which  *he 
psychic  impression  was  the  strongest.  The  first  requisite 
in  successful  recreation  is  a  complete  diversion  from  self, 
a  complete  submergence  of  self-consciousness,  which  in- 
hibits that  everlasting  introspection  of  our  physical  selves 
which  is  the  foundation  of  half  the  morbidity  of  the  world. 
How  this  can  best  be  done  in  the  individual  patient  is  a 
problem  for  the  physician  to  solve,  and  depends  upon  the 
age,  sex,  social  status,  intellectual  development,  and  other 
factors  which  go  to  make  up  the  complete  ego  of  the  pa- 
tient. The  physician  must  give  thoughtful  attention  to  the 
purely  physical  or  mechanical  aspects  of  many  forms  of 
recreation ;  in  other  words,  to  the  factor  of  muscular  exer- 


514  MODERN  PHYSIO-THERAPY. 

cise,  and  to  the  systematic  introduction  into  the  lives  of  his 
patients  of  such  recreation  as  is  suited  to  individual  needs. 
This  should  be  a  part  of  his  therapeutic  reasoning.  A 
proper  understanding  of  the  physiologic  laws  and  facts 
which  underlie  the  whole  subject  could  not  be  otherwise 
than  helpful  in  the  management  of  such  cases  as  require 
no  active  treatment  in  the  ordinary  sense  of  the  word,  but 
a  world  of  wise  guidance.  For  the  latter  they  naturally 
look  to  the  medical  adviser.  McCaskey  concludes  his  splen- 
did exposition  of  this  subject  with  the  admonition  of  Virgil 
that  "rural  recreations  abroad,  and  books  at  home,  are  the 
innocent  pleasures  of  a  man  who  is  early  wise."  For  addi- 
tional therapeutic  suggestions  along  this  line  see  REFLEX 
DISORDERS  and  FUNCTIONAL  DISORDERS. 

Tobacco. — The  use  of  tobacco  may  give  rise  to  func- 
tional disorders  of  the  heart  and  the  organs  of  special  sense 
(palpitation,  precordial  distress,  vertigo,  insomnia,  disturb- 
ances of  vision,  sounds  in  the  ears,  sensation  of  heat,  cold, 
tickling  or  formication  in  the  skin,  aberrations  of  taste, 
etc.).  Stop  the  use  of  tobacco  and  give  spinal  vibration  and 
negative  static  sprays.  Every  kind  of  stimulating  treatment 
(cold  douches  to  spine,  sunbaths,  etc.)  is  indicated. 

Tonsillitis. — The  acute  attack  requires  cold  moist  packs 
to  the  lower  extremities  and  a  Priessnitz  compress  on  the 
neck.  Treatment  of  this  kind  usually  aborts  the  attack. 
(See  INFLAMMATION  (AcuTE)  and  FEVERS.)  Gargle  with 
hot  water.  Negative  electrolysis  (needle)  for  broken-down 
follicles. 

Chronic  tonsillitis  is  usually  a  surgical  problem.  Metallic 
electrolysis  (positive  copper-electrode  to  tonsil,  negative  out- 
side of  neck)  might  be  tried.  Positive  static  spray  to  the 
neck,  also  high-frequency  applications  to  neck  or  directly 
to  the  tonsil.  (See  INFLAMMATION,  CHRONIC.) 

The  general  treatment  of  an  acute  attack  of  tonsillitis 
applies  to  inflammatory  conditions  of  the  pharynx  and 
larynx.  "Derivation"  to  the  lower  parts  of  the  body  and  to 
the  surface  is  the  essential  part  of  the  treatment.  Keep 


THERAPEUTIC  INDEX.  515 

emunctories  open.  Chronic  inflammation  of  the  pharynx 
and  larynx  requires  stimulation  of  the  surrounding  parts 
(neck,  etc.)  by  massage  and  faradism.  General  hygienic 
directions  are  essential.  (See  INFLAMMATION,  CHRONIC.) 
Vibration  over  cervical  vertebrae,  galvanism  (positive  pole 
as  near  as  possible  to  affected  region,  negative  pole  to  back 
of  neck),  positive  static  spray,  high-frequency  current,  local 
electric-light  bath,  Minin  light  to  front  and  sides  of  neck 
are  useful.  .  , 

Toothache. — (See  NEURALGIA.)  Dip  cotton  in  10  p.  c. 
cocaine  solution ;  put  cotton  in  cavity  of  tooth  and  connect 
with  positive  pole  of  galvanic  current  two  to  five  milliam- 
peres  for  five  to  ten  minutes,  negative  electrode  to  be  held  in 
the  hand.  Cataphoresis  as  described  is  useful  as  a  tem- 
porary anodyne.  Positive  pole  to  aching  gum,  negative  to 
opposite  side  of  neck  (galvanism)  or  positive  static  spray 
is  very  useful.  If  area  is  congested,  "derivate"  to  the  lower 
extremities. 

Tuberculosis  of  Glands. — Treatment  by  means  of  X- 
rays  has  been  referred  to  under  the  head  of  X-RAY  THERAPY. 
.Galvanism  is  useful  (negative  sponge  electrode  over  gland, 
positive  on  opposite  side  of  neck,  etc.,  the  object  being  to 
get  the  glands  between  the  two  poles).  Twenty  milliam- 
peres  or  more  for  twenty  minutes  every  other  day.  Ben- 
nett recommends  potassium  iodide  by  cataphoresis.  Tech- 
nique as  above.  High-frequency  current  locally  (ten  min- 
utes every  day)  is  useful.  If  inflammatory  reaction  is  pres- 
ent, the  Alinin  light  is  indicated.  If  the  glands  are  in  the 
extremities,  Bier's  stasis  is  available.  Massage  and  vibra- 
tion must  be  cautiously  used  on  account  of  the  danger  of 
causing  absorption  and  dissemination  of  tubercular  matter. 
Tubercular  glands  are  catch-basins  in  which  the  infectious 
material  is  collected  and  locked  up  to  save  the  system  at 
large.  The  object  of  treatment  must  be  to  kill  the  patho- 
genic factor  (stasis,  actinic  rays.  X-rays,  high-frequency 
current)  or  to  encourage  disintegration  and  discharge  ex- 
ternally (thermic  rays,  metallic  electrolysis).  In  tuber- 


516  MODERN  PHYSIO-THERAPY. 

cular  glands  metallic  electrolysis  is  recommended  by  some. 
A  small,  thin,  pointed  piece  of  zinc  is  inserted  through  a 
puncture  and  a  current  of  two  to  three  milliamperes  is  al- 
Icwed  to  pass  for  ten  to  twenty  minutes.  Superficial  tuber- 
cular glands  have  responded  favorably  to  prolonged  appli- 
cations of  radium.  In  all  cases  of  tubercular  glands  the 
general  condition  of  the  patient  must  not  be  lost  sight  of. 

Tuberculosis  of  Joints. — In  the  non-surgical  treatment 
of  tuberculosis  of  joints,  Bier's  "stasis"  seems  to  offer  the 
most  promising  results.  The  rationale  of  the  method  was 
foreshadowed  by  Rokitansky  as  early  as  1838.  He  called 
attention  to  the  fact  that  "lung-consumption  was  never 
found  in  patients  suffering  from  fullness  of  blood  in  the 
lungs."  Frerichs  in  1857  stated  that  consumption  was  com- 
mon in  diseases  of  the  pulmonary  artery  (anemia  of  the 
lungs)  but  hardly  ever  found  in  cases  of  hypertrophy  of  the 
heart  (hyperemia  of  the  lungs).  Applying  the  principle  to 
joint-consumption,  Bier  induces  venous  hyperemia  by  plac- 
ing a  compression-bandage  (rubber)  above  the  affected 
joint.  The  bandage  is  applied  in  several  turns  of  the  rub- 
ber firmly  enough  to  produce  a  moderate  degree  of  blood- 
stasis  below  the  bandage.  There  must  not  be  any  pain  or 
great  inconvenience  connected  with  the  application.  The 
limb  is  held  in  a  horizontal  position.  The  bandage  is  left  in 
position  for  several  hours  every  day  or  every  other  day. 
The  case  must  be  carefully  watched  and  symptoms  met  as 
they  present  themselves.  The  adoption  of  this  method  does 
not  exclude  ordinary  means  of  maintaining  surgical  cleanli- 
ness. The  advantages  of  immobilization,  extension,  derivat- 
ing  water-applications,  counter-irritations  by  cups  or  leeches 
should  under  suitable  conditions  not  be  lost  sight  of.  In 
favorable  cases  of  joint-consumption  associated  with  sup- 
purating fistulae,  the  tubercular  abscesses  eventually  change 
into  non-infectious  cold  abscesses.  The  discharge  lessens 
gradually  and  finally  ceases.  At  this  stage  effleurage  and 
passive  movements  are  indicated.  After  the  fistulae  are 
closed,  the  joint  is  handled  like  an  ordinary  stiff  joint.  Ab- 


THERAPEUTIC  INDEX.  517 

sence  of  pain  and  swelling  is  a  good  sign  of  extinction  of 
the  tubercular  process.  Under  the  circumstances  the  use  of 
the  small- thermic  cylinder  (baking)  is  advantageous,,  al- 
though Bier,  even  in  these  conditions,  resorts  to  passive 
rather  than  active  hyperemia.  For  this  purpose  the  vacuum- 
apparatus  is  useful.  The  high-frequency  current  and  the. in- 
direct positive  (static)  spray  have  a  gentle  stimulating  effect 
in  these  cases.  Vibration  along  the  course  of  the  lymphatics 
near  the  affected  joint  might  be  .employed  centripetally, 
mainly  in  conjunction  with  massage.  Massage,  local  elec- 
tric-light bath,  faradization  and  the  direct  negative  static 
spray  or  sparks  are  useful  in  restoring  the  whole  limb  func- 
tionally and  structurally,  after  the  joint  has  ceased  to  give 
rise  to  symptoms.  X-ray  treatment  has  been  referred  to  in 
the  chapter  on  X-RAY -THERAPY. 

Constitutionally  the  patient  should  receive  the  benefits 
of  fresh  air,  wholesome  food,  sunlight  and  skin-hygiene.  In 
rheumatic  and  syphilitic  cases  the  dry-heat  cylinder  or  the 
electric-light  bath  should  be  called  into  requisition. 

Tuberculosis  Pulmonum.— No  subject  in  clinical  medi- 
cine has  received  as  much  study  from  all  points  of  view  as 
the  "white  plague."  There  is  no  disease  that  means  so  much 
to  man  in  the  aggregate  as  this  murderous,  insidious,  omni- 
present and  ever-active  foe  of  the  human  family.  In  spite 
of  all  that  has  been  said  and  written  about  tuberculosis,  the 
practical  import  of  the  subject  can  not  be  too  often  pointed 
out  or  too  deeply  impressed.  When  we  consider  that  tuber- 
culosis causes  50  p.  c.  of  all  deaths  from  five  to  thirty  years 
of  age,  and  that  fully  one-half  of  these  cases  might  have 
been  either  prevented  or  cured,  we  can  approximately  esti- 
mate the  immensity  of  the  subject  and  the  inadequacy  and 
the  comparative  futility  of  the  efforts  which  have  been  made 
to  combat  this  foe.  It  is  impossible  to  realize  the  material, 
economic,  social,  moral,  intellectual  and  sentimental  Ipss 
which  mankind  sustains  as  the  result  of  the  disastrous  ac- 
tivity of  the  white  plague.  Compared  to  this  loss  all  other 
medical  and  hygienic  problems  pale  into  insignificance.  The 


518  MODERN  PHYSIO-THERAPY. 

solution  of  this  problem  should  be  uppermost  in  the  minds 
of  those  who  love  mankind  and  who  have  the  future  of 
our  country  at  heart. 

The  natural  history  of  tuberculosis,  as  exemplified  in 
the  relative  liability  of  certain  ages  and  social  states,  throws 
considerable  light  on  the  prophylaxis  and  hygiene  of  the 
disease.  J.  F.  Huber,  of  New  York,  in  a  statistical  review 
of  consumption,  states  that  the  mortality  is  lower  for  the 
married  than  for  either  the  single  or  the  widowed  and  lower 
for  women  than  for  men.  Brandt  finds  that  the  only  time 
when  the  death-rate  is  higher  for  women  than  for  men  is 
among  the  married  between  the  ages  of  fifteen  and  forty- 
five  years ;  and  here  it  is  also  higher  than  for  single  women 
during  the  same  ages.  These  data  are  in  large  part  ex- 
plained by  the  development  of  consumption  as  a  sequel  to 
exhausting  and  frequent  pregnancies.  The  highest  death- 
rate  of  all  is  among  the  widowers  under  forty-four  years. 
After  the  forty-fifth  year  the  rates  for  both  widowers  and 
widows,  while  higher  than  for  the  married,  were  lower  than 
for  the  single.  Hoffman  observes  that  the  death-rate  among 
widowers  is  highest  at  the  youngest  ages,  while  lowest  at 
the  most  advanced  periods  of  life.  The  higher  mortality  of 
widowers  at  early  ages  is  the  result  of  disease-transmission 
from  wife  to  husband.  There  would  seem  to  be  a 
lesser  liability  in  the  transmission  of  the  disease  from  hus- 
band to  wife;  possibly  because  the  husband  is  away  from 
home  a  large  part  of  the  time,  while  the  consumptive  wife 
being  so  much  more  at  home,  infects  the  household  the  more. 
Widowers  have  a  much  higher  mortality  than  widows  at 
corresponding  ages :  at  ages  up  to  forty-four  years,  67 
against  36;  from  forty-five  to  sixty- four  years,  49  against 
19;  from  sixty-five  years  on,  31  against  21.  The  high  death- 
rates  among  the  single  are  largely  due  to  occupations ;  to  the 
fact  that  a  far  higher  percentage  of  the  single  than  the  mar- 
ried live  in  cities,  where  the  devastation  is  much  greater  than 
in  the  rural  districts  ;  and  to  habits  of  life  detrimental  to  lon- 
gevity, such  as  alcoholism,  to  which  the  single  have  more 


THERAPEUTIC  INDEX.  519 

temptation  than  the  married.  This  last  factor  may  tend  also 
to  explain  the  greater  mortality  among  the  widowed  than 
among  the  married.  And  the  favorable  mortality  enjoyed 
by  the  married  is  certainly  due  in  large  measure  to  marriage 
being  inherently  a  process  of  natural  selection  toward  which 
only  the  fit  tend,  and  also  to  the  greater  regularity  and  so- 
berness of  living  essential  to  matrimony.  Particularly  is  this 
so  of  consumption,  a  disease  which  thrives  upon  irregulari- 
ties and  exposures. 

In  discussing  the  subject  of  lung-consumption  and  in 
considering  the  therapeutic  agents  which  are  at  our  com- 
mand in  the  treatment  of  the  disease,  we  must  not  lose  sight 
of  the  two  cardinal  features  of  each  and  every  case  of  this 
kind,  to  wit:  the  infection  in  and  of  itself  and  the  soil  which 
made  the  development  of  the  disease-producer  possible.  The 
bacillus  per  se  means  nothing  unless  we  consider  it  in  con- 
junction with  the  necessary  conditions  which  give  it  a 
chance  to  become  the  exciting  cause  of  a  consumptive  proc- 
ess. The  question  of  the  treatment  of  tuberculosis  would, 
therefore,  resolve  itself  into  the  solution  of  two  problems, 
viz. :  How  can  we  attack  the  vitality  of  the  bacillus  itself 
and  how  can  we  render  its  dwelling-place  as  uncomfortable 
as  possible  or  practically  uninhabitable?  These  two  prob- 
lems must  be  solved  jointly.  To  wage  war  against  the 
tubercle  bacillus  without  rendering  the  soil  sterile  leaves  the 
patient  liable  to  reinfection.  To  give  all  our  attention  to  the 
soil  means  to  ignore  the  essence  of  the  disease.  In  attempt- 
ing to  discuss  some  auxiliary  agents  which  may  help  us  in 
successfully  overcoming  the  ravages  of  this  murderous  foe, 
their  relative  merits  in  a  therapeutic  sense  can  be  best  un- 
derstood .by  considering  them  in  relation  to  the  double  pur- 
pose of  successful  treatment  mentioned  above. 

The  question  of  rendering  the  bacillary  cause  of  the  dis- 
ease inactive,  or  of  destroying  it  entirely,  suggests  itself  as 
the  first  step  in  the  treatment  of  tuberculosis.  The  bacillus 
thrives  in  lungs  which  are  badly  nourished.  The  less  fresh 
air  and  rich  arterial  blood  find  their  way  into  any  particular 


520  MODERN  PHYSIO-THERAPY. 

part  of  the  lung,  the  better  the  chances  for  rapid  and  prolific 
growth  of  the  germ.  The  oxygen  in  the  air  and  in  the  blood 
is  the  natural  enemy  of  the  bacillus.  The  first  and  most 
important  therapeutic  indication  is,  therefore,  the  necessity 
cf  pure  oxygen-laden  air.  In  order,  however,  to  become  a 
powerful  therapeutic  factor  the  air  must  have  a  chance  to 
enter  the  lungs,  particularly  those  secreted  and  distant  por- 
tions where  the  bacillus  has  found  lodgment  and  thrives. 
The  tuberculous  patient's  respiratory  movements  are  shal- 
low and  do  not  expand  the  lungs  as  they  should  in  order 
tc  aerate  the  infected  portions.  Consequently  it  is  of  im- 
portance to  adopt  measures  which  will  deepen  the  respira- 
tory movements.  To  encourage  the  patient  to  breathe 
slowly  and  deeply,  especially  out-of-doors,  is,  of  course,  of 
great  value.  The  effect  can  be  many  times  enhanced  if  ad- 
ditional care  is  taken  to  develop  the  muscular  cover  of  the 
chest  and  to  render  the  bony  framework  more  elastic.  The 
skin  of  a  consumptive  does  not  functionate  properly.  It  is 
inactive  from  anemia  or  ischemia  and  causes  .accumulation 
cf  toxic  material  within  the  system.  At  times  nature  makes 
a  gigantic  effort  to  counteract  these  states  of  auto-intoxica- 
tion and  the  numerous  incidental  symptoms  which  are  pro- 
duced by  toxemic  conditions.  At  such  times,  especially 
while  other  organs  are  comparatively  at  rest,  the  skin  be- 
comes over-active  (night-sweats).  The  skin,  therefore, 
and  through  the  skin  the  circulation,  both  qualitatively  and 
quantitatively,  should  receive  attention  at  the  hands  of  the 
medical  attendant.  The  fever-process  by  means  of  which 
the  gradually  succumbing  organism  tries  to  combat  the  ad- 
vancing foe,  :fighting  and  disputing  every  inch  of  ground, 
must  be  intelligently  directed  into  the  proper  physiological 
channel.  Alimentation  must  be  regulated  in  accordance 
with  the  biology  of  the  disease.  In  keeping  with  the  hy- 
gienic and  therapeutic  requirements  of  consumptive  cases, 
it  might  be  serviceable  and  will  certainly  aid  in  systematiz- 
ing the  practical  part  of  the  subject  to  give  these  physio- 


TlIfcRAPKUTIC     L\L)KX.  521 

therapeutic  agents  separate  discussion  in  conjunction  with 
the  treatment  of  an  average  case  of  tuberculosis  pulmonum. 

MASSAGE  OF  THE;  CHEST. — In -order  to  understand  and 
appreciate  the  therapeutic  value  of  massage  .it  is  proper  to 
acquire  the  manual  dexterity  which  alone  enables  us  to 
form  any  opinion. as  to  the  possibilities  of  mechanical  thera- 
peutic methods.  To  manipulate  the  muscles  of  the  chest- 
\\all  means  to  increase  their  blood-supply,  to  develop  them, 
to  render  them  stronger  and  more  :active.  This,  in  and  of 
itself,  means  more  vigorous  respiration,  especially  if  the 
mobility  of  the  thorax  proper  has  been  increased.  These 
effects  should  be  aimed  at  in  all  cases  of  lung-consumption, 
especially  during  the  early  stages.  The  modus  opcrandi  is 
subject  to  variation  owing  to  peculiarities  of  individual 
cases.  In  a  general  way  the  following  suggestions  will  be 
found  applicable  to  most  cases: 

The  patient  being  placed  in  the  dorsal  decubitus  the 
operator  begins  the  manipulation  over  the  costal  border, 
gently  picking  up  between  his. fingers  a  fold  of  skin  and  sub- 
cutaneous tissue,  lifting  it  from  the  bony  structures  be- 
neath and  gently  kneading  it  between  his  fingers.  Most  pa- 
tients will  be  found  to  be  "hide-bound,"  the  soft  tissues  of 
the  chest-wall  being  very  tense  and  hard  to  raise.  Event- 
ually, /.  c.  after  repeated  sittings,  the  fold  of  skin  will  come 
up  with  comparative  ease.  This  manipulation  requires  all 
possible  patience  and  gentleness.  L,ack  of  delicacy  would 
be  worse  than  worthless.  Gradually  the  manipulation  is  ex- 
tended over  the  whole  chest. .  This  form  of  massage  rtjay 
be  followed  by  gentle  stroking  in  a  horizontal  direction. 
^Each  sitting  should  last  from  fifteen  to  thirty  minutes,  to  be 
repeated  after  twenty-four  hours.  Within  a  week  or  two 
the  muscles  of  the  chest  will  be  less  tense  and  probably  a 
trifle  fuller.  At  this  juncture  exercise  of  the  thorax  might 
be  begun.  The  operator  places  his  flat  hand  over  the  right 
or  left  side  of  the  patient's  che.st,  making  firm  and  grad- 
ually increasing  pressure.  The  result  will  be  a  partial  im- 


522  MODERN  PHYSIO-THERAPY. 

mobilization  of  a  portion  of  the  chest.  If  the  patient  is  told 
tc  breathe  deeply,  the  effect  on  the  unengaged  side  of  the 
chest  will  be  more  or  less  intense.  The  patient  will  expand 
the  unengaged  side  of  the  chest  more  than  he  would  without 
immobilization  of  the  other  side.  The  operator  may  alter- 
nately place  his  hand  on  one  and  the  other  side.  He  may 
vary  the  procedure  by  placing  both  hands  on  the  lower  por- 
tion of  the  thorax  over  the  last  three  ribs,  thus  forcing  the 
patient  to  expand  the  upper  portions  of  the  chest  vigorously. 
In  this  way  the  expansive  power  of  the  chest  can  be  in- 
creased considerably,  rendering  inhalation  of  fresh  air  a 
therapeutic  factor  of  prime  value.  In  applying  these  me- 
chanical methods  to  individual  cases,  much  depends  upon 
the  judgment  and  the  individualizing  faculty  of  the  phy- 
sician. With  proper  care  and  judgment  an  immeasurable 
amount  of  good  may  be  derived  from  manipulations  of  this 
kind. 

GENERAL  MASSAGE. — In  many  cases  of  consumption,  es- 
pecially before  much  impairment  of  general  health  has  taken 
place,  the  invigorating  effect  of  massage  adds  much  to  the 
comfort  of  the  patient.  Considering  its  effect  on  the  circu- 
lation and  indirectly  on  the  metabolic  functions  of  the  or- 
ganism it  is  especially  indicated  in  those  cases  in  which 
weakness  and  marked  exhaustion  after  comparatively  little 
exercise  or  exertion  are  characteristic  symptoms.  Massage 
in  these  cases  takes  the  place  of  muscular  exercise  and,  if 
judiciously  administered,  is  a  very  serviceable  substitute. 
It  should  be  given  every  day  or  two  and  never  be  carried 
to  the  point  of  irritation.  Deep  effleurage  along  the  lym- 
phatics of  the  extremities  does  well  in  cases  in  which  symp- 
toms of  auto-intoxication  are  conspicuous,  e.  g.  headache, 
muscular  pains,  fatigue,  insomnia,  etc.  General  massage  in 
and  of  itself  is  often  sufficient  to  relieve  these  symptoms. 
It  frequently  prevents  night-sweats.  Superficial  massage 
should  be  avoided  on  account  of  its  irritating  effect  on  the 
skin  nerves.  All  massage-movements  in  cases  of  this  kind 
should  be  centripetal  with  a  view  of  depleting  the  venous 


THERAPEUTIC  INDEX.  523 

and  lymphatic  vessels.  If  the  tendency  towards  hemoptysis 
is  well-marked,  more  than  ordinary  discretion  should  be 
exercised  in  the  carrying  out  of  any  mechano-therapeutic 
measures. 

HYDRO-THERAPY. — To  increase  the  resisting  power  of 
the  organism  various  hydro-therapeutic  procedures  may  be 
resorted  to.  A  cold  moist  pack  (Priessnitz  method)  from 
the  feet  to  the  epigastrium  given  for  half  an  hour  every 
other  day  and  followed  by  deep  massage,  is  a  splendid  tonic. 
Patients  treated  in  this  manner  usually  sleep  and  digest  well 
and  are  less  liable  to  "catch  cold."  A  Priessnitz  pack  ap- 
plied to  the  whole  chest  relieves  dyspnea  and  distressing 
cough.  If  the  circulation  is  sluggish,  a  hot  moist  applica- 
tion is  safer.  The  cold  douche  applied  to  the  back  and  to 
the  lower  extremities  stimulates  the  mechanism  of  respira- 
tion and  prevents  venous  congestions  in  the  thorax.  In  all 
these  therapeutic  applications  the  dosage  as  to  duration,  fre- 
quency and  severity  of  treatment  should  be  carefully  adapted 
to  the  tolerance  of  the  individual  patient  and  regulated  as 
the  strength  of  the  patient's  organism  increases.  Partial 
packs  and  douches  pave  the  way  for  packs  and  douches  of 
the  whole  body.  The  general  cold  moist  pack  is  excellent 
in  cases  with  tolerably  good  circulation,  a  continued  low 
fever  especially  towards  evening  and  at  night,  and  ill-de- 
fined symptoms  of  auto-intoxication.  If  there  is  a  tendency 
towards  edema  and  hemoptysis,  a  full  bath  (warm)  or  a 
•mild  treatment  in  the  dry-heat  cylinder  or  electric-light  bath 
is  productive  of  much  benefit.  If  Priessnitz  packs  are  well 
borne  they  should  be  given  to  certain  regions  of  the  body 
successively,  changing  the  region  treated  from  day  to  day : 
lower  extremities,  next  day  the  back,  then  the  abdominal 
wall  and  so  forth.  Every  treatment  should  last  at  least  one 
hour  and  should  be  followed  by  vigorous  massage  of  the 
region  treated.  It  should  be  remembered  that  the  cold 
moist  pack  is  the  ideal  application  and  should  be  used  when- 
ever and  wherever  possible.  It  is  the  tonic  and  alterant  par 
excellence.  If  hot,  warm  or  tepid  applications  have  to  be 


524  MODERN  PHYSIO-THERAPY. 

substituted,  it  should  be  the  medical  attendant's  aim  to  hab- 
ituate and  educate  the  patient's  body  so  that  eventually  the 
cold  applications  and  the  reaction  .following  can  be  made 
use  of.  Many  times,  of  course,  this  will  be  a  difficult  task. 
The  "derivating"  method  should  be  resorted  to  in  cases  of 
hemoptysis.  A  well-applied  Priessnitz  pack  to  the  lower 
half  of  the  body  will  .stop  lung-bleeding  after  styptics  and 
heart-depressants  have  failed.  If  the  patient  is  confined  to 
his  bed  the  cold  sponge-bath  is  useful,  followed  ,by  massage. 
I  'riessnitz  packs  to  the  feet  for  three  or  four  hours  have  a 
sedative  and  even  a  hypnotic  effect.  To  enhance  the  effect 
of  .a  "derivating"  pack  a  rectal  injection  of  hot  water  be- 
fore or  after  the  pack  is  frequently  serviceable.  In  suitable 
cases  the  use  of  the  vapor-bath  js  not  objectionable.  It 
should  be  followed  by  a  gppd  dry  rub  and  absolute  .rest. 
Swimming  in  the  spring  and  summer  is  a  therapeutic  agent 
of  the  greatest  value  in  these  cases.  It  combines  the  advan- 
tages of  cold  water  and  reaction,  light,  exercise,  .fresh  air 
and  systematic  chest-exercise.  Niemeyer.  considers  system- 
atic .swimming  the  best  treatment  for  consumptives,  espe- 
cially if  they  can  camp  out  and  spend  all  their  time  in  the 
open  air  without  the  encumbrance  of  clothing  of  any  kind. 

.GYMNASTICS    QF     THE    RESPIRATORY     APPARATUS. — The 

tubercle-bacillus  would  give  us  little  concern  if  the  body  of 
the  consumptive  patient  did  not  offer  a  splendid  soil  for  its 
growth  and  dissemination.  The  colonization  of  the  tubercle 
bacillus  on  and  in  the  tissues  of  the  patient  is  preceded  by  a 
period  of  preparation  during  which  the  tissues  gradually 
become  a  suitable  habitat  for  the  germ.  The  process  of 
preparation  begins  with  neglect  of  the  lung-function.  In- 
asmuch as  imperfect  lung- function  may  be  conditioned  by 
inherited  bad  quality  of  the  body,  its  parts,  tissues  and  fluids, 
it  may  J>e  said  that  the  process  of  preparation  frequently  be- 
gins in  the  preceding  generation  or, still  further  back.  A 
wretched  physique,  small,  flat  chest,  poor  blood  and  other 
evidences  of  physical  inferiority  may  be  the  heritage  of  a 
human  being  in  whom  the  sins  of  its  fathers  are  thus  being 


THERAPEUTIC  INDEX.  525 

avenged.  Scrofula,  tertiary  or  inherited  syphilis,  rhachitis 
and  many  other  conditions  of  bodily  wretchedness  are  the 
punishment  which  nature  metes  out  to  those  who  sin  against 
fundamental  principles  of  hygiene.  (See  chapter  on  PER- 
SONAL HYGIENE.)  The  offender  may  be  an  individual,  a 
family,  a  tribe,  a  race.  The  sufferer  may  be  another  indi- 
vidual, another  family,  another  tribe,  another  race.  To  save 
the  species,,  nature  gradually  destroys  the  part.  This  is  the 
biology  of  tuberculosis.  Tuberculosis  is  not  inherited  per  se, 
but  all  the  conditions  favorable  to  its  development  are.  The 
moment  the  individual  is  born,  the  struggle  for  existence 
begins.  If  the  weapons  of  defense  are  absent,  the  doomed 
victim  of  a  progenitor's  misdeeds  succumbs.  The  fittest 
survives.  Marriage  is  a  crime  against  society  if  one  or  both 
of  the  contracting  parties  are  consumptives  or  otherwise 
physically  or  mentally  inferior.  It  should  be  prevented  by 
law.  This  phase  of  the  subject  is  a  hygienic  and  economic 
problem  which  should  be  solved  now  so  that  the  countless 
unborn  in  the  bosom  of  the  future  may  live.  It  is  a  problem 
that  will  never  be  solved  unless  man  in  the  aggregate  returns 
*to  first  principles  of  hygiene.  This  would  be  the  crowning 
effort  of  civilization  in  its  most  exalted  sense. 

The  habitat  of  the  tubercle-bacillus  is  not  always  in- 
herited. Sometimes  it  is  acquired  or  even  assiduously  cul- 
tivated. The  surroundings,  the  habits, -the  occupation  of  an 
individual  may  prepare  a  suitable  soil.  Lung-function  may 
be  neglected,  resulting  in  a  corresponding  atrophy,  shrinkage 
or  degeneration  of  the  lung  and  its  container,  the  bony 
frame- work.  The  result  would  be  deficient  oxygenation  of 
the  blood  and  a  corresponding  deterioration  of  the  quality 
of  the  whole  system.  The  diminution  of  the  amount  of  oxy- 
gen assimilated  by  the  lungs  leads  to  a  gradual  lessening  in 
the  number  and  quality  of  the  red  blood-cells.  Thus  the 
resisting  power  of  the  system  is  constantly  waning.  Alco- 
holism and  other  bad  habits  may  add  their  share  to  the  gen- 
eral collapse.  The  soil  is  ready  for  the  crop  of  hungry 


526  MODERN  PHYSIO-THERAPY. 

scavengers  that  are  being  carried  in  with  every  breath.  The 
battle  for  existence  has  begun. 

In  these  cases  of  incipient  phthisis  the  therapy  should 
begin  at  the  seat  of  the  trouble.  The  lungs  should  be  de- 
veloped, the  chest-wall  be  made  to  expand,  the  organism 
should  receive  its  physiological  share  of  fresh  healthy  blood. 
This  can  be  accomplished  by  strict  enforcement  of  the  hy- 
giene of  respiration  by  a  rational  system  of  lung-gymnastics. 
Patients  must  be  taught  to  breathe  and  must  be  given  the 
proper  kind  of  air  for  this  purpose.  This  is  the  philosophy 
of  chest-gymnastics  in  a  nutshell. 

A  consumptive  must  sleep,  eat,  play,  live  in  the  open  air. 
He  must  under  no  circumstances  be  confined  where  the  sup- 
ply of  fresh  air  is  limited.  This  is  rational  therapy  for  the 
individual  and  effective  prophylaxis  for  those  whose  health 
he  imperils  by  contact.  It  is  admitted  on  all  sides  that  the 
prevention  of  infection  is  even  a  greater  problem  than  the 
treatment  of  the  individual  patient. 

Light,  air  and  water  are  the  victorious  phalanx  that 
never  loses  a  battle  against  pathogenic  organisms.  They 
are,  as  L,.  F.  Flick,  of  Philadelphia,  Pa.,  correctly  remarks, 
the  natural  enemies  of  the  tubercle  bacillus.  Sunlight  and 
air  kill  it,  the  water  dissolves  it  out  of  its  cache,  so  that  light 
and  air  may  get  at  it.  The  bacillus  comes  out  of  a  host 
wrapped  up  in  broken-down  tissue  which  serves  as  a  cache. 
When  this  broken-down  tissue  is  deposited  in  a  house,  it  dries 
and  hardens,  and  the  bacilli  inside  remain  alive  for  a  long 
time.  When  it  is  deposited  in  the  open,  it  is  dissolved  or  dis- 
integrated and  soon  becomes  devitalized.  This  is  why  an  en- 
closure of  some  kind  plays  such  an  important  role  in  the 
propagation  of  tuberculosis.  In  an  enclosure  sunlight,  air 
and  water  can  not  get  at  the  tuberculous  matter  and  it  re- 
mains vital ;  out-of-doors  sunlight,  air  and  water  get  at 
it,  and  it  soon  becomes  sterile.  Houses  of  one  kind  and  an- 
other are  the  ordinary  means  of  spreading  tuberculosis. 
The  home  is  the  most  frequent  means  and  the  workshop  the 
next.  This  is  so  because  it  takes  prolonged,  intimate  con- 


THERAPEUTIC  INDEX.  527 

tact  with  a  person,  place,  or  thing  that  has  been  intensely 
contaminated  with  tuberculous  matter  to  give  rise  to  an  im- 
plantation. The  home  and  the  workshop  are  the  two  places 
where  environment  of  sufficient  intensity  of  contamination, 
and  contact  of  long  enough  duration  for  implantation,  most 
readily  can  exist.  Probably  three-fourths  of  all  cases  of 
tuberculosis  which  are  conveyed  from  person  to  person  are 
contracted  in  the  home,  and  the  other  fourth  is  contracted 
in  the  workshop. 

With  the  importance  of  air  as  a  prophylactic  agent  firmly 
fixed  in  our  minds  we  are  prepared  to  understand  the  mean- 
ing of  inhalation  as  a  therapeutic  measure.  To  exhort  pa- 
tients to  breathe  deeply  while  walking  in  the  open  air  is  ex- 
cellent advice,  but' not  of  much  practical  value,  because  pa- 
tients tire  of  monotonous  and  irksome  exertion  of  this  kind. 
We  must,  therefore,  resort  to  some  other  means  of  enforcing 
deep  inhalation.  Therein  lies  the  principal  therapeutic  value 
of  all  inhalation-methods  irrespective  of  the  agent  used 
(oxygen,  ozone, .medicated  vapors,  etc.).  The  value  lies  in 
the  act  of  inhalation,  not  so  much  in  the  character  of  the 
substance  inhaled,  unless  it  is  the  normal  physiological  lung- 
food,  namely  atmospheric  oxygen. 

The  inhalation  of  manufactured  oxygen  out  of  an  oxy- 
gen-tank is  being  advocated  by  some.  Theoretically  speak- 
ing, the  inhalation  of  oxygen  ought  to  be  the  ideal  treat- 
ment of  tuberculosis.  It  ought  to,  as  it  were,  supply  the 
missing  link  in  the  chain  of  vital  elements  which  are  antag- 
onistic to  the  bacillus  and  its  development.  More  especially 
ought  this  to  be  the  case  when  the  expanding  capacity  of 
the  lungs  is  being  increased  by  breathing  exercises  or  by 
thoracic  gymnastics.  Clinical  experience  does  not  confirm 
this  optimism  of  the  theoretical  physiologist.  The  absorp- 
tion of  oxygen  is  regulated  by  the  physiological  oxygen- 
carrying  capacity  of  the  blood.  This  again  is  in  direct  pro- 
portion to  the  relative  number  and  quality  of  the  red  cor- 
puscles. It  is  plain,  therefore,  that  the  forced  introduction 
of  oxygen  into  the  air-passages  does  not  necessarily  produce 


52$  MODERN   I'IIVSIO-TIIER'APY. 

an  equivalent  oxyg-enation  of  the  blood.  In  order  to  ar- 
rive at  distinctly  physiological,  i.  c.  curative,  effects  from 
this  method,  oxygen  must  be  not  only  inhaled  but  absorbed. 
The  blood  of  a  consumptive  is  wretchedly  poor  in  oxygen, 
because  the  elements  which  carry  it  are  poor  in  quality  and 
reduced  in  number.  Hence  it  is  clear  that  the  benefits  of 
oxygen-inhalation  are  to  a  large  extent  illusory  in  character. 
Then  again,  there  is  present  in  the  organism  that  indefinable 
element  which  demands  bulk  or  mass  of  physiological  fuel 
rather  than  concentration  or  extraction.  The  experiments 
which  have  been  made  with  concentrated  food-elements  as  a 
pure  unmixed  substitute  for  food  in  bulk  or  mass,  apply 
analogously  to  the  problem  of  oxygen- feeding.  The  disap- 
pointments which  have  followed  these  experiments  have 
demonstrated  that  the  human  body  and  the  test-tube  of  the 
physiologist  are  alike  only  in  a  provisional  sense.  The 
lungs  demand  bulk,  not  an  extracted  element.  They  crave ^ 
for  air,  not  for  oxygen.  Yet  oxygen-inhalation  is  not  al- 
together valueless.  Aside  from  being  a  potent  psychic  fac- 
tor it  gives  the  chest  a  gymnastic  training  and  helps  the  pa- 
tient to  breathe  deeply. 

What  has  been  said  concerning  oxygen-inhalation  holds 
good  in  regard  to  ozone-inhalation.  Ozone  is  an  irritating 
gas  and,  for  this  reason,  is  not  very  well  borne  by  the  air- 
passages  of  the  average  consumptive.  The  popularity  of 
the  static  machine  has  brought  ozone  prominently  before 
the  professional  mind.  Every  static  machine  has  its  ozone- 
generating  attachment,  and  the  enthusiastic  owner  of  such 
a  machine  never  wearies  of  extolling  the  virtues  of  ozone. 
That  the  enthusiasm  of  these  men  has  given  rise  to  many 
an  extravagant  claim  in  its  behalf,  it  is  quite  natural  to  sup- 
pose. The  odor  of  the  gas,  not  unlike  chlorine  gas,  is  dis- 
agreeable to  many  persons.  Unless  the  gas  is  largely  diluted 
with  air,  it  is  very  irritating  and  can  hardly  be  borne  by 
the  average  consumptive.  If  it  is  administered  in  a  badly 
ventilated  room,  the  procedure  is  of  questionable  value. 
Ozone  is  in  no  way  superior  to  oxygen  as  an  inhalant,  and 


THERAPEUTIC  INDEX.  529 

possesses  many  disagreeable  features  which  oxygen  cioes 
not.  After  all,  it  is  the  mechanical  act  of  deep  respiration 
wherein  lies  the  good  of  any  inhalation  method.  The 
mechanical  act  of  deep  breathing  does  the  good.  The  sub- 
stance inhaled  (and  there  are  thousands  recommended)  is 
the  psychic  and  persuasive  factor.  A  record  of  chest-ex- 
pansion should  be  kept. 

Deep  breathing  must  be  enforced  cost  what  it  may.  Nie- 
meyer  had  an  ingenious  system  of  making  his  consumptive 
patients  breathe  deeply.  He  divided  them  into  classes.  Each 
class  was  compelled  to  go  out  into  the  open  air  and  walk 
slowly  until  they  were  tired.  Then  the  members  of  the  class 
were  given  a  chance  to  lie  down  in  invalid  chairs  or  ham- 
mocks and  rest.  One  of  the  number  had  to  read  aloud  until 
another  one  took  his  place.  Occasionally  the  whole  class 
had  to  read,  sing,  whistle  or  play  on  wind-  or  brass-instru- 
ments. In  this  way  the  lungs  were  constantly  active.  The 
children  were  allowed  to  romp  over  the  grounds  at  pleasure. 
Those  that  were  too  weak  were  allowed  to  sit  in  the  open 
air  and  make  soap-bubbles  with  straws.  No  patient's  lungs 
were  allowed  to  remain  idle.  It  makes  no  difference  how 
inhalation  is  effected.  The  principal  thing  is  to  enforce  it. 
There  is  a  sanatorium  in  ^the  Black  Forest,  in  Germany, 
which — with  due  apology  to  the  author  of  "The  Divine 
Comedy" — has  a  sign  over  the  entrance  to  the  grounds 
which  reads  thus :  "Walk  slowly  and  breathe  deeply,  who- 
ever enter  here !" — Sudden  changes  in  the  temperature  of 
the  inhaled  air  should  be  avoided,  especially  if  the  bronchial 
symptoms  are  well  marked. 

DIET. — The  criterion  of  dietetic  directions  is  the  toler- 
ance of  the  individual  stomach  together  with  the  state  of 
individual  digestion.  Food  should  be  largely  tissue-building 
but  non-stimulating.  The  best  nitrogenous  foods  for  the 
average  consumptive  with  a  fairly  good  stomach  are  lean 
beef,  lamb,  chicken,  milk,  eggs,  peas,  beans,  lentils,  spinach. 
The  liberal  use  of  whisky,  by  many  thought  to  be  indis- 
pensable in  these  cases,  should  be  reserved  until  the  last 


530  Moni-ikx    I'll  YSIO-TIIKK.M-Y. 

stages  of  the  disease.  As  a  beverage,  mild  stimulant  and 
tonic,  beer  is  preferable  in  most  cases.  Too  much  care  can 
not  be  exercised  in  preserving  the  stomach  and  avoiding  ir- 
ritating articles  of  food.  The  stomach  is  the  mainstay  of  the 
patient.  If  necessary,  the  bowels  should  be  kept  open  by 
tepid  enemata.  The  diarrhea  of  consumptives  is  best  con- 
trolled by  irrigating  the  colon  with  warm  water.  In  cases 
that  do  not  show  much  febrile  reaction  a  non-irritating 
mixed  diet  is  permissible.  Extremes  of  temperature  in  foods 
and  all  articles  that  are  not  strictly  foods  should  be  avoided 
as  much  as  possible  (spices,  condiments,  etc.).  A  consump- 
tive should  sleep  or  rest  for  a  half  hour  to  an  hour  after  a 
meal.  If  patients  can  readily  digest  cold  milk,  the  latter  is 
a  good  substitute  for  cold  water.  In  many  cases  the  ap- 
petite can  be  stimulated  by  massage  and  hot  applications  to 
the  stomach.  The  weight  of  the  patient  should  be  watched. 
Individualization  is  the  key-note  of  success. 

PHOTO-THERAPY. — Next  to  fresh  air,  sunlight  is  the  most 
vital  therapeutic  element.  When  we  call  to  mind  the  part 
which  the  actinic  rays  of  sunlight  play  in  the  economy  of 
nature,  no  further  argument  is  necessary  to  prove  that  the 
treatment  of  tuberculosis  pulmonum  without  actinic  light 
is  unconditionally  a  hopeless  task.  To  begin  with,  light 
regulates  the  output  and  consumption  of  oxygen.  It  is, 
therefore,  the  necessary  and  all-powerful  regulator  of  oxida- 
tion, the  fundamental  basis  of  all  organic  life.  In  addition 
to  this,  it  is  the  great  and  universal  disinfectant  by  whose 
presence  .and  quantitative  influence  the  degree  of  resisting 
power  is  determined  by  which  animal  and  vegetable  bodies 
maintain  their  integrity  in  the  universal  struggle  for  exist- 
ence. Germ-life,  which  requires  but  little  oxygen  and  is 
devitalized  by  atmospheric  oxygen,  is  suspended  by  actinic 
light — (i)  on  account  of  the  directly  germicidal  power  of 
the  chemical  rays;  (2)  on  account  of  the  affinity  of  oxygen 
and  light.  For  this  reason  the  continued  exposure  to  actinic 
light  comes  second  in  point  of  importance  to  inhalation  of 
pure  oxygen-laden  air.  The  whole  body  c  f  the  patient 


THERAPEUTIC  INDEX.  531 

should  be  exposed  so  that  the  whole  body-surface  ma)'  re- 
ceive the  benefits  of  regeneration  and  oxidation.  Light  coun- 
teracts the  effects  of  auto-intoxication  by  encouraging  th;* 
escape  of  toxines,  mainly  CO2,  through  the  skin,  both  in 
the  form  of  gas  and  vapor,  not  to  speak  of  the  active  excre- 
tion which  is  coincident  with  dianhoresis. 

The  use  of  the  concentrated  chemical  rays  of  one  or 
more  arc-lights  is  a  valuable  therapeutic  agent.  In  cases  of 
apical  infection  concentration  of  the  liorit  on  the  chest-wall 
directly  in  front  of  the  seat  of  infection  has  been  practiced 
with  some  degree  of  success.  That  the  germ  is  thus  killed 
in  its  haunts  by  the  direct  action  of  light,  is  questionable. 
That  the  intense  effect  on  the  oxidation  and  general  activity 
of  a  region  so  near  the  nidus  of  bacterial  vegetation  is  bound 
to  increase  the  resisting  power  of  the  infected  parts,  is  more 
than  likely.  While  all  these  photo-therapeutic  applications 
are  interesting  and  not  without  great  therapeutic  effect,  it 
must  not  be  forgotten  that  sunlight  over  the  whole  body- 
surface  is  the  ideal  light-treatment.  During  the  summer- 
months  it  should  be  given  in  the  open  air.  When  the 
weather  is  cold,  the  solarium  should  be  resorted  to. 

RADIO-THERAPY. — The  X-rays  promise  to  be  of  great 
diagnostic  value.  Whether  their  therapeutic  effect  in  cases 
of  tuberculosis  pulmonum  is  worth  considering,  is  doubtful. 
The  researches  of  Pott  have  shown  that  the  tubercle-bacillus 
resists  the  action  of  the  X-rays.  Even  if  such  were  not  the 
case,  it  must  be  remembered  that  the  rays  from  a  soft  tube 
do  not  penetrate,  while  those  from  a  hard  tube  lack  thera- 
peutic quality.  In  addition  to  this  the  danger  of  destruction 
of  relatively  sound  tissue  is  not  inconsiderable  in  view  of  the 
length  and  frequency  of  the  exposures  which  would  be  re- 
quired, and  the  low  vitality  of  the  tissues  of  a  consumptive. 
This  seems  to  be  the  status  of  the  question  at  present.  For 
the  relief  of  pain  (pleurodynia  and  pleuritic  stitch)  the  X- 
ravs  seem  to  render  good  service. 

ELKCTRO-THERAPY. — Galvanism,  faradism  and  static 
electricitv  have  a  field  of  usefulness  in  the  treatment  of 


532  MODERN  PHYSIO-THERAPY. 

tuberculosis.  Within  the  range  of  their  physiological  action 
they  are  capable  of  relieving  certain  symptoms.  Cataphore- 
sis  has  received  but  scant  recognition  at  the  hands  of  electro- 
therapeutists  although  its  usefulness  in  suitable  cases  seems 
to  be  beyond  question.  Mild  positive  electrolysis  in  thin 
persons  (one  electrode  in  front,  another  posteriorly,  both 
charged  positively, — the  negative  electrode  at  some  distant 
point)  seems  to  promise  much  in  view  of  the  affinity  of  the 
positive  pole  for  oxygen.  The  force-modality  which  prom- 
ises to  become  a  very  important  feature  of  treatment  in  the 
future,  is  the  high-frequency  current.  The  reader  will  re- 
member the  remarkable  effects  which  currents  of  high-fre- 
quency are  capable  of  producing  on  the  most  vital  functions 
of  the  whole  organism.  The  ideal  mode  of  application  is  the 
use  of  D'ArsonvaFs  cage  or  the  diasolenic  body-cylindT. 
The  systemic  effects  are  so  marked,  even  after  three  or  four 
treatments,  that  the  virtue  of  this  method  can  not  possibly 
be  questioned.  To  intensify  the  effects  of  the  general  treat- 
ment and  to  concentrate  the  action  of  the  current  on  the  seat 
of  the  disease,  Oudin's  double  resonator  is  the  proper  instru- 
ment to  use,  the  patient  being  comfortably  seated  between 
the  discharging  discs  of  the  instrument,  one  anteriorly  and 
the  other  posteriorly.  The  salutary  effects  of  these  applica- 
tions have  been  verified  by  many  observers,  who  kept  a  rec- 
ord of  the  sputum-examinations  and  of  the  patient's  weight. 
TREATMENT  AS  A  SOCIAL  AND  ECONOMIC  PROPOSITION. — 
The  rational  solution  of  the  tuberculosis  problem  consists  in 
the  cure  of  the  infected  person  and  in  the  protection  of  those 
who  are  not  infected.  At  this  advanced  day,  with  all  our 
knowledge  of  the  biology  of  the  disease,  the  home-treatment 
of  this  disease  is  out  of  the  question.  Consumptives  must  be 
given  a  superlative  degree  of  air  and  light  at  all  times.  At 
the  same  time  they  must  be  removed  from  places  where  they 
can  endanger  the  health  of  others.  This  logically  places  the 
tuberculosis-problem  in  the  hands  of  the  health-authorities, 
municipal  or,  better  still,  state  or,  best  of  all,  national.  In 
each  county  there  should  be  one  or  more  sufficiently  large 


THERAPEUTIC  INDEX.  533 

tracts  of  land  to  accommodate  tents  and  cottages  for  con- 
sumptive patients,  who  must  live  here  among  healthful 
primitive  surroundings  and  under  the  care  of  a  competent 
medical  officer.  A  centrally  located  administration-building, 
equipped  with  all  modern  resources  of  hygiene  and  therapy, 
should  be  at  his  disposal.  He  should  be  an  accomplished 
physio-therapeutist  and  bacteriologist.  He  should  not  be 
hampered  by  lack  of  funds  or  assistance,  but  be  given  ample 
sway  to  carry  out  modern  principles  of  hygiene  and  therapy. 
He  should  have  the  authority  of  the  law  to  back  him  up  in 
his  work  and  the  co-operation  of  a  medical  state-board  to 
control  the  work.  Housing  a  consumptive  should  be  on  a 
par  with  housing  a  small-pox  patient.  The  old  stereotyped 
advice  of  doctors  who  tell  their  patients  to  go  to  California, 
Colorado,  Mexico  or  the  Carolinas,  involves  hardships, 
financial  and  otherwise,  that  are  hardly  in  proportion  to  the 
good  which  most  of  these  patients  derive.  Many  a  poor 
sufferer  might  have  remained  near  his  home  and  received 
the  benefits  of  rational  treatment  along  the  lines  indicated. 
The  climatic  and  atmospheric  advantages  of  the  States 
named  hardly  compensate  for  the  inconveniences,  the  dis- 
comfort, the  homesickness  and  the  lack  of  competent  pro- 
fessional attention  which  are  in  store  for  all  but  the  wealthy. 
Cincinnati  is  the  first  municipality  in  the  United  States 
where  a  municipal  hospital  for  consumptives  is  being  con- 
ducted with  as  much  success  as  the  insufficient  resources 
will  allow.  Patients  are  housed  up  in  several  buildings,  but 
have  the  advantage  of  air,  light  and  natural  surroundings. 
By  conducting  a  vigorous  educational  campaign  throughout 
tiie  country,  the  people  might  be  taught  the  necessity  of 
system  and  united  effort  in  the  treatment  of  consumptives 
and  the  protection  of  the  non-infected.  The  National  Gov- 
ernment, through  a  department  of  public  health,  must 
eventually  take  hold  of  this  problem.  This  is  the  only  way 
in  which  the  nation  as  a  whole  can  be  protected  and  pre- 
served. Additional  information  concerning  the  clinical 
features  of  tuberculosis  will  be  found  under  the  head  of 


5.U  MODERN  PHYSIO-THERAPY. 

FUNCTIONAL  DISORDERS,  REI;UCX  DISORDERS,  AUTO-INTOXI- 
CATION, and  in  the  chapter  on  the  THERAPY  OF  LIGHT. 
Symptomatic  therapy  is  suggested  under  the  head  of  COUGH, 
NIGHT-SWEATS,  HEMORRHAGE,  DIARRHEA,  etc.,  etc. 

Typhoid  Fever  is  the  disease  in  the  treatment  of  which 
the  earliest  laurels  were  won  by  strictly  physiological 
therapy.  There  is  not  an  intelligent  practitioner  to-day  who 
does  not  practice  physiological  methods  persistently,  at  least 
in  the  treatment  of  this  one  disease.  Typhoid  fever  was 
at  one  time  one  of  the  most  murderous  infections,  the  mor- 
tality being  as  high  as  one  death  in  two  or  three  cases.  To- 
day the  mortality  is  not  more  than  one  in  twenty  cases. 
This  is  an  achievement  of  hygiene,  diet  and  hydro-therapy. 
In  conjunction  with  this  statement  it  is  but  fair  to  correct  the 
historical  error  which  gives  Dr.  Brand,  a  military  surgeon 
of  Stettin,  credit  for  originating  a  method  which  he  really 
adopted  from  Vincenz  Priessnitz  who  taught  and  practiced 
the  hygienic,  dietetic  and  hydriatic  method  in  the  treatment 
of  typhoid  fever  forty  years  before  Brand  published  his 
statistics. 

In  order  to  understand  the  rationale  of  the  modern  treat- 
ment of  typhoid  fever,  it  is  above  all  things  necessary  to 
be  familiar  with  the  physiological  effects  of  cold  water  and 
the  relation  of  these  effects  to  the  fever-process.  The  state- 
ment that  the  febrile  condition  in  and  of  itself  is  an  element 
of  danger,  is  not  unequivocally  true.  Fever,  as  we  at  this 
advanced  day  are  ready  to  admit,  is  essentially  salutary  be- 
cause it  is  the  process  of  intensified  combustion  and  metab- 
olism by  which  nature  effects  the  expulsion  of  morbid  ele- 
ments and  restoration  of  normal  conditions.  Those  who 
fear  fever,  commit  the  fundamental  error  of  confounding 
fever  and  high  temperature.  The  latter  is  usually  the  out- 
ward manifestation  of  the  former.  The  intensity  of  the  one, 
however,  is  not  necessarily  in  proportion  to  the  other.  Or- 
dinarily the  body  burns  up  at  a  temperature  of  99°  F.  If 
the  oxidation  of  the  body  is  accelerated  and  intensified,  the 
heat  of  combustion  is  greater  and  the  temperature  corre- 


Tr.i.R. \PEUTIC  INDEX.  535 

spondingly  higher.  In  this  sense  fever  and  high  temperature 
are  correlative  to  each  other.  If  the  organism  has  been  in- 
fected with  toxic  material,  direct  irritation  of  the  heat-con- 
trolling centers  may  result  in  great  variations  in  the  body- 
temperature.  In  a  case  of  this  kind  the  temperature  would 
be  in  no  way  dependent  upon  the  fever-process.  We  must 
remember  two  facts,  /.  c.  ( i )  fever  per  sc  is  not  a  destructive, 
but  a  constructive  element ;  and  (2)  fever  and  temperature 
are  in  no  sense  of  the  word  synonymous. 

In -applying  cold  water  to  the  body-surface,  the  reduction 
of  the  temperature  is  only  a  secondary  consideration,  physio- 
logically speaking.  Cold  applications  are  made  to  bring 
about  a  cutaneous  anemia.  The  sudden  and  forcible  con- 
traction of  the  blood-vessels  of  the  skin  is  followed  by  a 
reaction  consisting  in  the  so-called  secondary  hyperemia. 
(See  chapter  on  HYDRO-THERAPY.)  The  vessels  dilate  and 
in  this  way  warmth  and  increased  function  of  the  skin  are 
produced  by  a  primary  cold  application.  Increased  skin- 
function  is  coincident  with  more  active  excretion  of  morbid 
material  and  more  intense  radiation  of  heat-units.  Thus  the 
temperature  is  reduced  by  a  lessening  of  the  amount  of 
fever-producing  toxines  and  by  elimination  of  heat.  Hence 
it  is  absurd  to  leave  a  patient  in  a  cold  bath  until  the  tem- 
perature drops.  This  plan  is  based  on  an  amateurish  con- 
ception of  the  action  of  cold  water  in  typhoid  fever.  Cyano- 
sis, collapse  arid  even  death  have  followed  this  misinter- 
pretation of  hydro-therapeutic  principles.  The  best  illustra- 
tion of  the  principle  involved  is  furnished  by  the  antipyretic 
effect  of  the  warm  and  even  the  hot  bath.  In  cases  where 
the  system  is  much  depressed  and  cutaneous  reaction  is  un- 
certain, the  warm  bath  is  a  safer  water-application.  The 
cutaneous  vessels  are  directly  affected  and  the  activity  of  the 
skin  is  at  once  stimulated.  Excretion  (by  gas,  vapor  or 
sweat)  begins  and  the  temperature  drops.  The  continued  ap- 
plication of  cold  to  the  skin  can  not  be  too  emphatically  con- 
demned. Suddenly  induced  anemia  of  the  skin  must  always 
and  promptly  be  followed  by  increase  in  the  cutaneous  circu- 


536  MODERN  PHYSIO-THERAPY. 

lation  and  stimulation  of  skin-function.  Any  hydro-thera- 
peutic measure  that  fails  in  this,  is  wrong  in  principle  and 
incorrect  in  practice.  This  holds  good,  not  only  in  typhoid 
fever,  but  in  all  conditions  characterized  by  high  tempera- 
ture. Let  us  remember  that  sweat  is  concentrated  heat. 

A  continued  fever  like  typhoid  fever  should  be  watched 
with  the  aid  of  the  thermometer.  If  the  temperature  is  not 
more  than  102°  F.  one  or  more  cold  sponge-baths  daily 
are  sufficient.  If  the  temperature  exceeds  102°  F.,  the  ap- 
plication of  a  general  cold  moist  pack  for  forty-five  minutes 
to  an  hour  is  indicated.  One  of  these  Priessnitz  packs  every 
day  is  sufficient  if  the  temperature  is  not  higher  than  102°  F. 
If  the  temperature  rises  within  three  hours  after  the  pack, 
another  application  should  be  made  or  the  patient  subjected 
to  immersion  in  a  tub  (Brand's  method).  In  cases  charac- 
terized by  continued  high  fever  it  is  excellent  practice  to 
give  three  packs  daily  and  an  immersion  (tubbing)  in 
the  interval,  unless  the  patient  shows  signs  of  great  weak- 
ness, when  the  cold  sponge-bath  (either  by  direct  applica- 
tion of  a  towel  or  sponge  or  by  rubbing  the  patient  through 
a  cold  moist  sheet  in  which  he  is  enveloped)  should  be  sub- 
stituted. Tubbing  can  be  done,  especially  in  children,  by 
wrapping  the  patient  in  a  dry  sheet,  grasping  the  latter  be- 
low the  feet  and  above  the  head  of  the  patient,  and  grad- 
ually lowering  patient,  sheet  and  all,  into  the  water.  Undue 
excitement  and  exhaustion  are  centra-indications.  If  cu- 
taneous reaction  is  sluggish  or  imperfect,  warm  and  even 
hot  water  should  be  used.  Sometimes  alternation  of  heat 
and  cold  is  indicated.  In  this  way  the  antipyretic  effect  can 
be  combined  with  powerful  stimulation.  At  all  times  it  is 
of  vital  importance  to  be  able  to  individualize.  Brisk  rub- 
bing of  the  skin  during  and  after  a  cold  bath  is  an  effective 
way  of  promoting  reaction  and  preventing  collapse.  In 
cases  characterized  by  headache  and  severe  brain-symptoms 
the  cold  moist  pack  gives  considerable  symptomatic  relief, 
delirium,  stupor,  subsultus,  etc.,  being  lessened. 

Persistent  headache  may  call  for  cold  applications  to  the 


THERAPEUTIC  INDEX.  537 

head  and  hot  applications  to  the  feet.  In  cases  which  are 
treated  with  the  general  cold  moist  pack  this  is  hardly  ever 
necessary.  Abdominal  symptoms  (tympanites)  may  require 
a  local  cold  moist  pack  to  the  abdomen.  Diarrhea  is  usually 
controlled  by  starch- water  or  rice-water  injections.  Con- 
stipation is  best  treated  by  means  of  rectal  irrigation.  Bed- 
sores should  be  prevented  by  cold  ablutions  and  the  use  of 
air-pillows. 

The  sick-room  should  have  a  wealth  of  air  and  light. 
The  temperature  in  the  room  should  be  65°  F.  or  a  trifle 
higher.  Mental  rest  is  imperative.  The  bed  should  be  kept 
scrupulously  clean.  Feather-beds  are  an  unhygienic 
nuisance.  The  ejecta  should  not  be  allowed  to  remain  in 
the  room.  The  food  is  to  be  regulated  according  to  the 
directions  which  are  given  under  the  head  of  DIET  IN  ACUTE 
FEVERS.  From  the  end  of  the  second  week  the  diet  is  of 
great  significance.  Food  should  be  small  in  quantity  but 
liberal  in  quality.  Stimulants  like  coffee  or  alcohol  are  in- 
dicated in  cases  of  great  weakness.  Patient  should  not  take 
solid  food  until  the  temperature  has  been  normal  for  at  least 
two  weeks. 

Peritonitis  is  a  serious  complication,  but  not  necessarily 
fatal.  It  should  be  treated  by  "derivating"  packs  applied 
to  the  abdomen  and  to  the  lower  extremities.  Perforation 
is  fatal  unless  the  opening  is  closed  by  agglutination  or  by 
surgical  means.  Owing  to  the  ajmost  invariably  fatal  char- 
acter of  perforation,  abdominal  section  under  these  circum- 
stances offers  the  only  prospect,  and  is,  therefore,  justifiable. 

Symptoms  and  complications  must  be  met  pro  re  nata. 
The  principal  feature  in  the  management  of  a  typhoid-fever 
case  is  the  hydro-therapeutic  treatment  of  the  febrile  condi- 
tion. All  else  pales  into  insignificance.  Proper  hygienic 
and  dietetic  regulations  are  taken  for  granted.  The  nurse 
in  charge  of  the  case  is  the  one  overtowering  figure  in  whose 
hand  the  weal  and  woe  of  the  patient  are  placed.  Without 
intelligent  co-operation  and  a  strong  will  on  the  part  of  the 
nurse,  the  most  modern  treatment  planned  by  the  best  phy- 


53S  MODKRX   PHYSIO-THERAPY. 

sician  will  avail  nothing.  For  this  reason  the  modern  hos- 
pital is  by  all  odds  the  best  place  for  typhoid  cases.  (For 
further  information  concerning  symptomatic  features  and 
complications  of  typhoid  fever  see  HEMORRHAGE  and  other 
special  subjects.) 

Ulcer  (Chronic). — To  overcome  the  indolence  of  a 
broken  surface  and  encourage  the  formation  of  healthy 
granulations,  the  surface  should  be  exposed  to  the  actinic 
rays  (sunlight  or  Finsen-apparatus)  as  often  and  as  long  as 
practicable.  Once  every  day,  or  every  other  day,  the  ulcer 
should  be  exposed  to  the  Minin  light  (heat-rays  to  increase 
arterial  blood-supply  and  local  metabolism).  If  this  regime 
is  persistently  carried  out,  healing  will  promptly  take  place. 
Exuberant  granulations  can  be  removed  by  simple  positive 
electrolysis  or  by  metallic  electrolysis  (copper,  zinc  or  mer- 
cury-amalgam, positive  electrode  to  ulcer)  or  by  a  sun-glass. 
A  negative  static  spray  is  useful.  High-frequency  applica- 
tions produce  most  happy  results  in  many  cases.  The 
greater  the  spark-gap  between  ulcerated  surface  and  elec- 
trode, the  more  intense  the  local  reaction.  X-rays  are  fre- 
quently effective  (soft  tube  every  other  day  for  five  to  ten 
minutes  at  short  range).  Prolonged  immersion  in  hot  water 
is  of  value  if  the  ulcer  is  on  the  arm  or  leg.  Immersion  of 
the  whole  limb  is  proper.  These  directions  hold  good  in 
all  forms  of  chronic  ulceration.  In  many  cases  attention  to 
the  general  condition  of  the  patient  is  essential.  Locally  the 
rules  of  surgical  cleanliness  should  be  enforced. 

United  States  (Climate,  etc.). — Change  in  the  sur- 
roundings of  a  patient  is  often  a  therapeutic  measure  of 
great  significance.  In  order  to  adapt  the  new  surroundings 
to  the  needs  of  the  individual  patient's  condition,  knowl- 
edge of  the  climatic  and  other  peculiarities  of  different  sec- 
tions of  the  country  is  essential.  The  following  practical 
classification  is  quoted  from  Cohen's  "System  of  Physio- 
logic Therapeutics"  (Blakiston,  Philadelphia)  where  more 
detailed  information  will  be  found.  The  list  includes 
Canada,  the  United  States,  Mexico  and  neighboring  islands. 


THERAPEUTIC  INDEX.  539 

MARINE  CLIMATES. 

Warm  sedative:  Bermuda,  the  Bahamas,  the  West  In- 
dies. 

Moderately  cool:   The  channel  islands  of  California. 

Cool  stimulant:  Long  Island,  Nantucket,  Martha's 
Vineyard,  Cape  Cod,  the  Isles  of  Shoals. 

Cold  stimulant:  Newfoundland,  Cape  Breton,  Nova 
Scotia,  Campobello,  Mount  Desert. 

COAST  CLIMATES. 

Warm  sedative:  The  shores  of  South  Carolina,  Georgia, 
Florida,  Gulf  of  Mexico,  San  Diego,  Coronado. 

Cool  stimulant:  New  Jersey  coast,  Lakewood,  Long 
Island  Sound,  Narragansett  Bay,  western  end  of  Cape  Cod, 
north  shore  of  Massachusetts,  coast  of  New  Hampshire  and 
Maine,  San  Francisco. 

Cool  sedative:  Portland,  Ore.;  Tacoma,  Seattle, 
Olympia. 

INLAND  CLIMATES  (low  elevation,  0-1500  feet). 

Warm  and  moist:  Louisiana,  eastern  and  central  Texas, 
Mississippi,  eastern  Arkansas. 

Warm  and  dry:  Aiken,  S.  C. ;  Thomasville,  Ga. ;  Phoe- 
nix and  Salt  River  Valley,  Yuma,  Ariz. ;  Redlands,  River- 
side, San  Bernardino,  Pasadena,  San  Gabriel,  Ojay  Valley, 
Cal. ;  lake  districts  of  the  interior  of  Florida  during  the 
winter. 

Moderately  warm  and  dry:  Pine  region  of  New  Jersey 
in  the  summer  months. 

Desert  climate:    Mojave  desert. 

Cool  ami  moist:  St.  Lawrence  Valley,  northern  Califor- 
nia and  western  Oregon  and  Washington  (not  on  the 
coast). 

Cold  and  moist:  Winnipeg,  Port  Arthur,  Sault  Ste. 
Marie,  Duluth. 

Cold  and  moderately  dry:  Southern  Minnesota,  North 
and  South  Dakota,  Muskoka  Lake  region  in  Ontario,  south- 
ern counties  of  New  York  and  adjoining  counties  in  Penn- 
sylvania, pine  region  in  Wisconsin  and  central  Michigan, 


540  MODERN  PHYSIO-THERAPY. 

northwestern  Connecticut,  Berkshire  district  in  Massachu- 
setts. 

INLAND  CLIMATES  (moderate  elevation,  1500-4000  feet). 

Warm  and  dry:  Mesilla  and  Lower  Pecos  Valley,  Las 
Cruces,  southern  New  Mexico,  Guadalajara,  Monterey, 
southern  Arizona,  southeastern  California  near  the  Sierra 
and  coast  ranges. 

Moderately  warm  and  dry:  Asheville,  N.  C. 

Cool  and  dry:  Eastern  Oregon  and  Washington,  valleys 
of  Idaho  and  Montana,  southern  Wyoming,  El  Paso,  Texas. 

Cool  and  Moist:  Adirondack  Mountains,  White  Moun- 
tains, Mount  Kineo,  Me. ;  Eaglesmere,  Pocono,  Pa. ;  Deer 
Park,  Md. ;  western  Virginia  and  North  Carolina. 

INLAND  CLIMATES  (high  elevation,  over  4000  feet). 

Warm  and  dry:  Northern  New  Mexico,  central  Mexico, 
southern  Colorado,  northern  Arizona. 

Cool  and  dry:  Denver,  Colorado  Springs,  Manitou  and 
mining  regions  of  Colorado,  Montana  and  Idaho,  Yellow- 
stone Park,  Lake  Tahoe,  Nev.,  Glacier,  Field,  Banff,  Cal- 
gary, Rossland,  B.  C. 

Cool  and  moderately  moist:  Roan  Mountain,  N.  C. ; 
Mountain  Lake,  Va. 

Uranium  is  found  in  metallic  ores  containing  pitch- 
blende (uraninite),  the  latter  being  a  compound  oxide  con- 
taining 8i^<  per  cent  of  uranium,  4  p.  c.  of  lead  and 
l/2  p.  c.  of  iron  with  oxygen  and  water,  and  sometimes 
magnesia,  manganese  or  silica.  Pitchblende  is  found  in 
Bohemia,  Saxony,  Cornwall  (England)  and  in  Colorado. 
Prof.  Henri  Becquerel,  of  Paris,  discovered  in  1896  re- 
markable radiations  emanating  from  uranium  and,  through 
his  discovery,  established  the  phenomenon  of  "radio-ac- 
tivity" as  a  scientific  fact.  The  radiations  from  uranium 
are  known  as  "Becquerel  rays." 

In  investigating  Becquerel  radiations  from  uranium 
Prof.  Pierre  Curie  and  his  talented  wife,  Mme.  Sklodowska 
Curie,  in  1898  extracted  a  substance  from  uranium  which 
had  four  times  the  radio-active  power  of  metallic  uranium. 


THERAPEUTIC  INDEX.  541 

The  new  substance  -was  called  POLONIUM  in  honor  of  Mme. 
Curie's  native  land,  Poland. 

In  the  same  year  the  Curies  found  another  radio-active 
substance  in  pitchblende  and  called  it  RADIUM.  It  requires 
5,000  tons  of  uranium-residues  to  produce  approximately 
two  pounds  of  radium.  What  therapeutic  significance  is  to 
be  attached  to  radium  future  developments  will  show.  It 
has  been  used  in  cases  of  superficial  tuberculosis  with  ap- 
parently good  results.  In  superficial  cancer  radium  has 
been  of  service  in  a  few  authenticated  cases.  The  author 
has  verified  the  analgesic  effects  of  radium  in  several  cases 
of  malignant  disease.  Caspari's  experiments  have  shown 
that  radium  possesses  marked  germicidal  properties.  It 
suspends  the  vitality  of  the  micrococcns  prodigiosus  in 
about  three  hours. 

In  1899  Debierne  extracted  another  radio-active  sub- 
stance from  uranium  and  called  it  ACTINIUM.  Its  rays  are 
deviable.  Another  radio-active  substance  extracted  from 
uranium  is  THORIUM.  In  point  of  radio-active  power  it 
ranks  next  to  radium. 

The  radio-activity  of  uranium  is  the  unit  of  measure- 
ment. Radium,  if  it  has  a  radio-activity  of  7,000,  possesses 
7,000  times  the  radio-active  power  of  uranium. — Reference 
to  this  important  subject  is  made  in  the  chapter  on  FORCE 
AND  FORCE-MODALITIES.  For  detailed  information  on  ra- 
dium and  other  radio-active  substances  the  reader  is  re- 
ferred to  an  excellent  monograph  on  the  subject,  written 
by  Wm.  J.  Hammer,  of  New  York. 

Uremia. — The  therapy  consists  in  active  elimination 
(hot  bath,  dry  heat,  hot  packs,  colon-irrigation,  catheteriza- 
tion,  cupping  or  leeches  over  the  loins,  venesection).  For 
additional  information  see  BRIGHT'S  DISEASE;  (CHRONIC). 

Uterine  Inertia. — Faradism  up  to  the  point  of  tolerance, 
one  pole  in  utero,  the  other  on  the  abdomen  or  over  lumbar 
region.  A  bi-polar  vaginal  electrode  is  useful.  Massage 
of  fundus.  Also  applicable  to  post-partum. hemorrhage. 


542  MODKRN  PHYSIO-THERAPY. 

Vaginismus. — In  addition  to  forcible  dilatation  the  vise 
of  a  mild  faradic  current  (very  rapid  interruptions)  is  indi- 
cated as  a  muscular  tonic.  If  local  nutrition  is  poor,  a  mild 
galvanic  current  is  preferable  (current  reversed  frequently). 
These  applications  are  made  by  means  of  a  vaginal  electrode, 
one  pole  on  the  abdomen.  A  bi-polar  vaginal  electrode  is 
sometimes  useful.  Applications  every  day  or  two  for  ten 
minutes  or  more.  Intra-vaginal  vibration  is  effective  in 
some  cases  in  which  the  spasm  is  of  local  origin  (derange- 
ment of  local  sensory  nerves).  A  soft-rubber  attachment  of 
suitable  thickness  should  be  employed.  Local  hot  vapor- 
baths  followed  by  cold  douches  have  an  excellent  effect. 

Valvular  Diseases  of  the  Heart. — The  condition  of  one 
or  more  of  the  heart-valves  may  be  one  of  insufficiency  giv- 
ing rise  to  a  regurgitation  (backward  flow)  of  the  blood. 
Thus  there  may  be  mitral,  aortic,  tricuspid  or  pulmonic  in- 
sufficiency and  resulting  regurgitation.  The  valve-openings 
may  be  narrowed  by  cicatricial  formations,  deposits  or  veg- 
etations producing  a  condition  of  stenosis  causing  a  partial 
obstruction  to  the  blood-current.  Thus  there  may  be  mitral, 
aortic,  tricuspid  or  pulmonic  stenosis  and  resulting  obstruc- 
tion. Familiarity  with  the  anatomy  of  the  heart  and  the 
physiology  of  the  circulation  is  necessary  in  order  to  under- 
stand the  peculiar  changes  in  the  heart  itself  and  the  sec- 
ondary effects  on  the  circulatory  system  which  follow  in- 
sufficiency or  stenosis  of  one  of  the  heart-valves.  These 
changes  are  subsequent  to  the  crowding  back  of  the  blood- 
mass,  and  as  a  result  the  increase  of  blood-pressure  in  a 
retrograde  direction  and  the  alterations  in  the  whole  cir- 
culatory system. 

Nature  tries  in  conditions  of  this  kind  to  stay  the  inevita- 
ble result  by  fortifying  the  weakening  heart-muscle.  In 
this  way  the  disturbed  relation  of  arterial  and  venous  pres- 
sure is  temporarily  restored.  The  heart-muscle  increases  in 
size  to  meet  the  demand  for  more  pumping  power.  The 
changes  in  the  structure  of  the  heart  are  the  so-called  com- 


THERAPEUTIC  INDEX.  543 

pensatory  hypertrophies.  They  represent  Nature's  attempt 
to  prolong  the  life  of  the  patient. 

The  therapeutic  indications  in  all  cases  of  valvular  dis- 
ease of  the  heart  are  necessarily  similar  because  the  ef- 
fects of  all  valvular  regurgitattons  or  obstructions  are  prac- 
tically identical.  In  the  case  of  a  regurgitation,  we  are  deal- 
ing with  a  decrease  in  the  pumping  power  of  the  central 
circulatory  organ.  In  the  case  of  an  obstruction,  the  pump- 
ing power  per  sc  is  unimpaired,  but  the  caliber  of  a  main- 
pipe  is  reduced.  In  either  case  the  proportion  between  the 
quantity  of  blood  in  the  pulmonary  circulation  and  in  the 
general  circulation  is  disturbed.  Stagnation  is  the  result 
with  uneven  distribution  of  the  blood-mass  in  the  different 
parts  of  the  circulatory  system.  The  lungs  are  overfilled, 
the  flow  of  the  blood  in  the  large  veins  of  the  general  circu- 
lation becomes  more  and  more  sluggish,  more  blood  is 
crowded  back,  while  the  blood  coming  from  the  lungs  or  en- 
tering the  aorta  becomes  less  and  the  arterial  pressure  in 
the  system  at  large  is  gradually  reduced.  The  pulmonic 
hyperemia  causes  dilatation  of  the  pulmonic  vessels,  espe- 
cially of  the  capillaries  surrounding  the  alveolar  spaces. 
Eventually  the  delicate  capillaries  can  not  resist  the  pressure 
of  the  constantly  increasing  blood-mass.  Rupture  of  capil- 
lary vessels,  a  hypostatic  congestion  and  catarrhal  conditions 
are  the  result.  The  chronic  hyperemia  causes  hyperplastic 
and  hypertrophic  changes  in  the  tissues.  The  lung- 
parenchyma  increases  in  size,  connective  tissue  proliferates 
and  a  cirrhotic  or  fibroid  condition  of  the  lungs  is  the  result. 

The  stagnating  blood-mass  increases  the  pressure  in  the 
venous  circulation  of  the  liver,  the  spleen,  the  pancreas,  the 
kidneys,  in  fact  all  the  organs  of  the  body.  Chronic  passive 
hyperemias  in  these  organs,  especially  in  the  kidneys  and  im- 
pairment of  the  secretory  and  especially  the  excretory  func- 
tion cf  these  organs  are  the  result.  The  lowered  heart's 
action  and  the  pressure  of  the  sluggish  venous  circulation 
produce  capillary  stagnation  throughout  the  system.  Owing 


544  MODERN  PHYSIO-THERAPY. 

to  the  defective  excretion  there  is  a  retention  of  liquids  in 
the  body,  causing  distinct  liquefaction  of  the  blood.  The 
aqueous  elements  of  the  blood  pass  through  the  vessel-walls 
in  large  quantities  and  enter  the  connective  tissue  causing 
edematous  swellings. 

The  natural  history  of  valvular  heart-disease  as  outlined 
above  contains  the  therapeutic  indications.  The  objects  of 
the  treatment  should  be  to  diminish  the  quantity  of  fluids  in 
the  body  (depletion  of  the  pulmonary  and  the  general  ve- 
nous circulation,  unloading  the  heart  and  the  kidneys)  and 
in  this  way  to  re-establish  as  far  as  possible  the  proportion 
between  arterial  and  venous  pressure  and  thus  counteract 
the  pathologic  changes  in  the  different  structures  and  or- 
gans of  the  body. 

These  effects  represent  the  physiological  purposes  of  ra- 
tional therapy  in  the  treatment  of  organic  diseases  of  the 
heart.  In  this  respect  the  physio-therapeutic  methods  oc- 
cupy a  commanding  position  because  they  are  directly 
adapted  to  the  working  out  of  these  mechanical  problems. 

The  physiological  effects  of  diminution  of  the  liquids  of 
the  body  concern  primarily  the  vascular  system.  The  less- 
ened amount  of  the  blood  which  circulates  in  and  through 
them  causes  the  vessels  to  accommodate  themselves  to  the 
diminished  blood-mass  and  blood-pressure.  As  a  result  the 
vessels  contract  unless  the  walls  of  the  vessels  have  by  long- 
continued  intra-vascular  pressure  lost  their  tone.  This  is  the 
case  in  the  last  stages  of  circulatory  disease.  After  forced 
abstraction  of  fluid  from  the  body,  the  physiological  equilib- 
rium can  be  maintained  by  regulating  the  amount  of  the 
fluids  which  enter  the  body  (drink).  The  secondary  effect 
of  forced  abstraction  of  fluids  from  the  body  is  the  absorp- 
tion of  the  serum  which  has  accumulated  in  the  cavities  of 
the  body  and  in  the  connective  tissue  (dropsy). 

Systemic  exercise  is  of  superlative  value  as  an  agent  for 
the  reduction  of  liquids  in  cases  of  organic  heart-disease. 
The  Swedish  method  consists  in  thorough  massage  and  pass- 
ive movements  of  all  parts  of  the  body  administered  every 


THERAPEUTIC  INDEX.  545 

day  or  two.  This  plan  is  applicable  in  weak  patients  or 
during  inclement  weather.  It  must  be  carried  out  in  a  thor- 
ough and  systematic  manner  to  be  of  any  avail.  Slight  im- 
provement usually  follows  after  two  or  three  weeks  of  treat- 
ment. The  Nauheim  plan  was  evolved  from  the  Swedish 
method.  It  consists  in  massage  and  in  the  systematic  ap- 
plication of  mild  concentric  and  excentric  Swedish  move- 
ments. The  patient's  strength  must  not  be  taxed.  Resist- 
ance must  be  slight  and  never  carried  to  the  point  of  fatigue, 
dyspnea  or  palpitation.  Individualization  means  everything 
in  these  cases.  The  patient  is  treated  every  day,  massage 
and  movements  being  properly  measured  and  alternated.  In 
addition  thereto  baths  in  saline  water  and  other  hydro- 
therapeutic  measures  are  employed  to  stimulate  the  skin  and 
aid  in  the  eliminative  process.  M.  J.  Oertel,  whose  excellent 
monograph  on  this  subject  should  be  read  by  every  physician 
who  attempts  to  treat  heart-disease,  advises  active  exercise 
and  gives  explicit  directions  concerning  respiratory  gym- 
nastics, which  are  accentuated  by  the  patient  walking  up  hill. 
The  patient  is  made  to  take  ten  or  twelve  steps  ascending  a 
hill  and  then  instructed  to  rest  in  the  standing  posture.  In- 
spiration is  long,  deep  and  forcible,  while  expiration  is  short 
and  rapid.  Excretion  through  the  lungs  and  through  the 
skin  is  increased  and  the  exchange  of  gases  in  the  lungs 
becomes  more  nearly  normal.  Oertel  supplements  thera- 
peutic mountain-climbing  with  inhalation  of  compressed  air. 
The  object  of  the  latter  is  the  mechanical  expansion  of  the 
lungs  after  the  decrease  of  aqueous  elements  has  begun. 
After  four  to  six  weeks  of  respiratory  gymnastics  as  out- 
lined above,  inhalations  of  compressed  air  four  or  six  times 
daily,  thirty  minutes  each  time  are  given,  beginning  with 
i-ioo  atmosphere  and  gradually  increasing  the  pressure. 
The  treatment  must  be  continued  for  months  and  years. 

The  degree  of  blood-pressure  in  the  veins  depends 
largely  upon  the  position  of  the  body  as  a  whole,  the  posi- 
tion of  the  several  parts  of  the  body  and  the  relative  state  of 
contraction  and  relaxation  of  the  muscles.  Pressure  is  less- 


546  MoDKKX     I'lIVSIO-TlIKKAPY. 

ened  by  putting  the  body  in  the  horizontal  position.  It 
would  appear,  therefore,  that  the  best  effects  can  be  pro- 
duced by  putting  the  patient  on  his  back  and  administering 
deep  centripetal  effleurage.  Passive  movements  of  the  ex- 
tremities should  be  added  to  enhance  the  depleting  effect. 
This  is  a -good  mechano-therapeutic  measure  for  advanced 
cases  and  where  the  application  of  Oertel's  method  is  not 
practical  or  practicable. 

Vibration  can  be  added  to  accentuate  the  effect  of  mas- 
sage. Vibrate  centripetally  along  the  course  of  the  large 
venous  trunks  in  the  extremities.  If  compensation  is  good, 
vibration  over  the  precordial  space  improves  the  quality  and 
retards  the  rate  of  the  heart-beats.  Central  stimulation 
along  the  upper  dorsal  vertebrae  is  useful  in  many  instances. 
Vibratory  treatments  should  not  be  too  long  continued. 

Hydrortherapy  and  thermo-therapy  are  powerful  agents 
in  the  treatment  of  organic  heart-diseases.  In  careless  or 
reckless  hands  they  are  dangerous  agents.  If  properly  used, 
their  value  can  hardly  be  overestimated.  They  help  in  the 
slow  dehydration  of  the  system  which  should  be  the  first  aim 
in  the  therapy  of  heart-lesions.  The  large  thermic  cylinder 
is,  in  my  estimation,  a  most  valuable  adjunct.  Its  use  should 
be  mild  and  be  adapted  to  the  features  of  the  individual  case. 
It  should  be  used  as  a  gentle  diaphoretic  agent  once  or  twice 
a  week.  The  temperature  need  not  exceed  200°  F.  The 
patient  should  perspire  without  much  heat  or  depression. 
General  massage  should  always  be  administered  after  a 
sweat-bath  of  this. kind.  Instead  of  the  the"rmic  cylinder,  the 
general  electric-light  bath,  the  warm  vapor-bath,  the  warm 
sitz-bath  or  hot  sparks  to  the  lower  portions  of  the  body, 
might  be  made  use  of.  Cold  applications  are  contra-indi- 
cated in  heart-cases  on  account  of  the  sudden  congestion  of 
the  deep  vessels  coincident  with  the  primary  cutaneous  ane- 
mia which  is  produced  by  cold  packs,  etc.  (See  chapter  on 
THE  Usrs  OF  HEAT  AND  COLD.)  The  heart  might  not  be 
equal  to  the  suddenly  imposed  tasks  of  increased  function. 
The  benefits  from  gaseous  baths  as  given  at  Nauheim  are 
largely  suggestive. 


THERAPEUTIC  INDEX.  547 

All  the  therapeutic  agents  named,  especially  active  move- 
ments and  dry  heat,  are  contra-indicated  in  cases  of  imper- 
fect compensation,  of  dilatation,  atheromatous  degeneration 
of  the  vessel-walls,  arterio-sclerosis  of  the  heart  and  blood- 
vessels. They  are  only  applicable  when  the  vessels  are  in 
fairly  good  condition  and  the  heart  is  protected  by  a  com- 
pensatory hypertrophy.  Inflammatory  conditions  of  the 
heart  are  a  contra-indication  to  precordial  vibration. 

The  patient  must  be  enjoined  to  avoid  anything  and 
everything  that  might  tax  the  working  power  of  his  heart, 
c.  g.  excitement,  fright,  exertions,  sexual  indulgence,  etc. 
All  the  energy  of  the  patient,  especially  in  the  advanced 
stages,  should  be  therapeutically  utilized. 

Regulation  of  the  patient's  diet  is  very  essential.  The 
quantity  of  liquids  must  be  reduced  as  much  as  the  patient 
will  stand.  This  is  in  keeping^  with  the  idea  of  dehydration 
of  the  system,  which  Oertel  considers  the  alpha  and  omega 
of  therapy  in  these  cases.  Alcohol  and  tobacco  should  be 
avoided.  Meat  can  be  allowed  in  moderate  quantities  if  the 
stomach  will  stand  it.  In  the  first  stage  of  valvular  dis- 
ease of  the  heart  a  consistent  vegetable  diet  is  physiologically 
indicated  to  aid  in  the  process  of  oxidation  and  prevent 
waste-accumulation.  In  the  advanced  stages  the  adminis- 
tration of  tissue-building  foods  is  necessary.  (See  FATTY 
DEGENERATION  OF  THE  HEART.)  The  colon  should  be  irri- 
gated every  second  or  third  day  with  the  patient  lying  down 
on  the  left  side. 

The  general  management  of  a  case  should  include  all 
the  hygienic  necessities  that  people  ordinarily  are  apt  to 
ignore.  Sun-baths  help  to  dehydrate  the  system.  Pleasant 
surroundings  and  agreeable  mental  impressions  preserve  the 
vitality  of  the  nervous  system.  It  must  be  remembered  that 
valvular  heart-disease  per  se  is  incurable.  The  object  of 
the  therapeutic  directions  given  is  to  establish  a  modus 
I'i'i'cndi  that  will  enable  the  patient  to  live  as  long  and  as 
comfortably  as  is  possible  under  the  circumstances.  The  pa- 
tient is  on  the  down-grade.  If  he  follows  the  plan  outlined 


548  MODERN  PHYSIO-THERAPY. 

he  will  postpone  the  inevitable  and  render  his  life  more 
agreeable  to  himself  and  more  useful  to  his  surroundings 
than  he  could  if  he  fails  to  adapt  his  mode  of  living  to  the 
requirements  of  his  condition.  The  habitual  use  of  so-called 
heart-tonics,  heart-stimulants,  etc.,  can  not  be  too  emphat- 
ically condemned.  (Oertel.)  Their  use  is  analogous  to  the 
whip  by  which  a  wind-broken  horse  is  made  to  run  until 
exhaustion  of  the  vital  forces  causes  it  to  collapse.  Digitalis, 
spartein,  strophanthus,  glonoin,  etc.,  undoubtedly  produce  a 
display  of  increased  energy  on  the  part  of  the  heart,  which 
tact  makes  them  available  as  ready  means  of  bridging  a 
patient  over  a  momentary  weakness.  Their  use  is  in  such 
a  case  the  lesser  of  two  evils.  To  employ  them  in  the  regu- 
lar treatment  of  these  ailments  is  purely  symptomatic  treat- 
ment and  physiologically  not  justifiable.  The  treatment  of 
circulatory  disturbances  must  be  centrifugal.  Regulate  the 
circulation  in  the  vascular  system  and  you  will  regulate  the 
heart.  The  drug-dispensing  empiric  proceeds  rice  versa,  i.  e. 
in  a  centripetal  direction.  He  whips  up  the  heart  in  order 
to  adjust  irregularities  of  the  vascular  system.  He  whips  up 
the  kidneys  by  diuretics  in  order  to  prevent  waste-retention, 
which  is  the  physiological  sequence  of  the  disproportion  in 
the  arterial  and  venous  pressure  in  the  kidneys.  It  may  be 
more  convenient  to  proceed  in  this  manner,  but  it  certainly 
is  not  on  the  level  of  physiological  knowledge  which  the 
researches  of  Leyden,  Pettenkofer,  Schott,  Funke,  Seguin, 
l.andois  and  others  have  given  us  on  the  subject  of  the 
physiology  of  the  circulatory  apparatus. 

A  number  of  electrical  modalities  can  be  advantageously 
employed  in  valvular  disease  of  the  heart.  Systemically  the 
high-frequency  current  is  of  the  greatest  benefit  (D'Arson- 
valization).  It  can  be  applied  locally  by  means  of  a  vacuum- 
tube  to  the  dorsal  section  of  the  cord  and  to  the  sides  of  the 
neck  (vagus).  Galvanization  or  faradization  is  useful  in 
impending  heart-failure.  The  positive  sponge-electrode  is 
placed  below  the  ear,  the  negative  over  the  heart  and  moved 
about.  The  current  should  be  mild,  and,  if  it  is  a  faradic 
current,  rapidly  interrupted.  Static  electricity  can  be  ad- 


THERAPEUTIC  INEEX.  549 

ministered  by  means  of  insulation  (positive  sedative,  nega- 
tive stimulating),  negative  spray  to  spine  (stimulating), 
general  positive  spray  (sedative).  The  electric  water-bath 
is  beneficial,  but  requires  great  caution.  Exposure  of  the 
precordium  to  Minin  rays  frequently  has  a  prompt  anodyne 
effect. 

The  details  of  treatment  depend  to  a  large  extent  on  the 
features  of  the  individual  case.  The  suggestive  influence  of 
the  physician  is  a  powerful  factor  in  preparing  the  soil  for 
physiological  treatment.  Much  will  depend  on  the  func- 
tional integrity  of  the  stomach.  It  should  be  preserved  and 
protected  at  all  hazards.  Keep  the  mind  of  the  patient  off 
his  physical  condition.  For  this  purpose  a  change  of  sur- 
roundings is  often  advantageous.  The  beneficent  effects  of 
the  Nauheim  treatment,  with  all  due  regard  for  the  impor- 
tance of  mechano-therapy  and  hydro-therapy,  are  in  no  small 
measure  attributable  to  the  suggestive  influence  of  the  place 
itself,  a  veritable  paradise  on  earth,  about  which  hover  the 
traditions  of  the  thousands  of  invalids  who  have  thither 
wended  their  weary  way  to  find  hope  and  health  in  the  ro- 
mantic pine-forests  of  the  Taunus  and  its  world-famed 
health  resort. 

Varicose  Veins. — Locally,  attempts  should  be  to  lessen 
the  pressure  of  the  venous  blood  (horizontal  position,  elastic 
bandage).  Centripetal  massage  is  valuable.  Begin  half- 
way between  hip  and  knee  and  force  the  venous  blood  into 
the  abdominal  cavity.  After  five  minutes'  massage  start  at 
the  knee,  a  few  minutes  afterwards  below  the  knee,  etc.,  the 
object  being  to  empty  the  veins  above  in  order  to  make  room 
for  the  ascending  venous  blood  from  below.  Massage  must 
be  gently  and  carefully  executed  and  should  be  followed  by 
a  warm  compress  to  stimulate  local  metabolism.  Large 
varices  should  receive  special  massage.  Instead  of  the 
pack  a  negative  static  spray  can  be  given  for  ten  minutes. 

The  general  treatment  should  include  abdominal  mas- 
sage, irrigation  of  the  colon  and  a  strictly  vegetarian  diet 
(See  AUTO-INTOXICATION.) 


550  MODKRN     I'lIYSIO-TllKKAPY. 

Varix. — Insert  positive  platinum-needle  in  the  vein, 
negative  pole  near  by,  galvanic  current,  ton  milliamperes  for 
five  to  ten  minutes.  When  clot  has  formed,  reverse  the  cur- 
rent to  loosen  the  needle.  Cleanliness  is  essential. 

Vascular  Tumors. — Positive  electrolysis  (see  first  part 
of  the  book)  is  commonly  used  in  the  removal  or  rather  in 
the  destruction  of  angiomata,  birth-marks,  cirsoid  aneurisms, 
varices,  nodules  and  dilated  vessels  in  acne  rosacea,  moles, 
polypi,  fungi,  warts,  verrucse,  and  wine-marks.  One  or 
more  needles  are  used,  depending  on  the  depth  and  extent  of 
the  lesion.  The  object  of  positive  electrolysis  is  to  oblit- 
erate the  small  arterioles.  Bennett  recommends  the  appli- 
cation of  a  positively  charged  small  wet  cotton  or 
sponge  pad  after  using  sodium-  chrom-ethylate  on 
the  -surface,  negative  pole  near  by,  five  to  ten  mil- 
liamperes, five  to  ten  minutes  every  week.  Xeis- 
wanger  advises  introduction  of  several  needles  by  means  of 
a  multiple  needle-holder  connected  negatively,  positive  pole 
near  by  or  in  patient's  hand,  application  to  be  continued  un- 
til considerable  blanching  around  the  point  of  needle-punc- 
ture has  taken  place.  This  is  negative  electrolysis.  The 
same  autnor  advises  the  use  of  a  negative  needle  introduced 
below  the  epidermis  parallel  to  the  skin  until  blanching  oc- 
curs. Several  punctures  of  this  kind  can  be  made  during  the 
same  sitting.  If  the  vascular  element  predominates,  posi- 
tive electrolysis  is  preferable.  In  ordinary  warts  and  other 
growths  largely  composed  of  cellular  and  fatty  tissue,  nega- 
tive electrolysis  is  given  preference. 

X-rays  have  been  used  successfully  in  the  treatment  of 
wine-marks  and  other  telangiectatic  conditions.  Applica- 
tions are  made  with  soft  tube,  five  to  ten  minutes  every  other 
day  until  local  reaction  shows.  Finsen-rays  cause  pigmenta- 
tion in  the  naevoid  surface,  thus  substituting  a  yellowish  dis- 
coloration for  the  red  mark.  To  produce  this  effect  an  arc- 
light  of  fifty  amperes  and  more  must  be  used.  Cases  of 
wine-marks  have  been  successfully  treated  by  thermic  solar 
rays,  concentrated  by  means  of  a  sun-glass.  In  using  posi- 
tive or  negative  electrolysis,  much  depends  on  the  technique 


THERAPEUTIC  INDEX.  551 

of  the  operator,  who  must  be  careful  not  to  cause  too  much 
destruction  and  subsequent  disfiguring  cicatrization. 

Versions  of  the  Womb. — Principles  of  treatment  sim- 
ilar to  those  mentioned  under  the  head  of  FLEXIONS.  Re- 
moval of  the  cause  is  paramount  (inflammatory  conditions, 
exudates,  adhesions,  etc.).  Pessaries  are  obsolete.  Mas-, 
sage  and  faradism  are  the  most  valuable  agents  after  in- 
flammatory symptoms  have  subsided. 

Vomiting  of  Pregnancy. — Galvanization  of  the  vagus 
(side  of  neck  below  ear  to  intra-clavicular  space)  or  phrenic 
(side  of  neck  to  epigastrium)  is  beneficial.  Positive  static 
spray  to  stomach  and  spine.  Vibration  to  side  of  neck,  stom- 
ach and  dorsal  vertebras  is  useful.  (See  REFLEX  DISOR- 
DERS.) 

X-ray  Burns. — Moist  warmth  or  heat  seems  to  possess 
considerable  palliative  and  curative  virtue.  If  the  "burn" 
is  on  the  arm  or  leg,  continuous  immersion  of  the  extremity 
in  warm  water  is  by  far  the  most  effective  treatment. 

X-ray  Coil  (portable). — Diagnostic  X-ray  work  will 
never  serve  its  purpose  adequately  until  X-ray  coils  of  suffi- 
cient power  are  constructed  that  can  be  moved  from  place 
to  place.  Many  a  patient  can  not  be  taken  to  a  hospital  or 
a  radiographer's  laboratory  for  an  X-ray  examination  (e.  g. 
injuries  of  the  hip-joint,  severe  gunshot  wounds,  etc.). 
These  patients  can  riot  be  given  the  benefit  of  X-ray  diag- 
nosis unless  the  X-ray  machfhe  is  brought  to  their  bedside. 
The  accompanying  illustration  shows  a  portable  equipment, 
the  energy  being  furnished  by  a  secondary  battery. 

X-ray  Statistics. — In  the  chapter  on  X-RAY  THERAPY 
and  elsewhere  reference  has  been  made  to  the  manifold 
therapeutic  uses  of  the  mysterious  rays  of  Roentgen.  The 
references  made  were  largely  suggested  and  influenced  by 
the  author's  experience.  For  the  sake  of  completeness  and 
in  order  to  afford  the  reader  a  broader  view,  of  the  subject, 
the  author  has  gathered  the  statements  of  at  least  fifteen  of 
the  best  and  most  reliable  observers  from  all  parts  of  the 
world  and  offers  the  following  resume  as  a  fair  estimate  of 
the  clinical  uses  of  the  Roentgen  rays  at  the  present  time. 


552  MODERN  PHYSIO-THERAPY. 

All  observers  agree  that  in  the  treatment  of  skin-cancer 
(epithelioma)  the  X-rays  are  at  their  best.  The  time  which 
elapses  before  a  healthy  action  is  noticeable,  is  subject  to 
variation.  The  location  of  the  trouble,  the  general  condi- 
tion of  the  patient  and  the  relative  skill  of  the  operator  have 


A  PORTABLE  X-RAY  EQUIPMENT. 

much  to  do  with  the  comparative  promptness  with  which 
the  individual  case  yields.  On  general  principles  it  may  be 
stated  that  the  cases  of  skin-cancer  which  are  not  curable 
by  means  of  the  X-rays  are  exceptional. 

Cancer  of  the  tongue,  soft  palate  and  larynx  are  some- 
times benefited  by  X-ray  treatment,  although  the  cured  cases 
are  rare  but  sufficiently  well  authenticated  to  demon- 
strate the  possibilities  of  the  X-rays  in  the  conditions  re- 
ferred to.  Nearly  all  observers  agree  that  the  progress  of 


THERAPEUTIC  INDEX.  553 

the  diseased  condition  is  retarded  by  the  X-rays  and  thus 
the  life  of  the  patient  prolonged. 

In  regard  to  cancer  of  the  breast  a  singular  diversity  of 
opinion  seems  to  prevail,  even  concerning  the  propriety  and 
relative  efficacy  of  the  X-rays  in  the  early  stages  of  the  dis- 
ease. That  the  cure  of  primary  breast-cancer  is  possible 
under  radio-therapeutic  treatment,  is  admitted  in  view  of  a 
number  of  cases  of  this  kind  which  have  been  reported. 
Most  of  the  observers  favor  surgical  interference  followed 
by  X-ray  treatment. 

A  few  cases  of  uterine  cancer  that  are  supposed  to  have 
been  cured  by  the  X-ray,  have  been  reported.  In  all  these 
cases  the  seat  of  the  malignant  process  was  in  the  cervical 
portion  and  treatment  was  given  per  vaginam.  The  vagina 
is  protected  by  an  opaque  speculum.  Treatment  through 
the  abdominal  wall  is  admittedly  of  doubtful  value. 

In  rectal  cancer,  if  the  seat  of  the  trouble  is  not  extensive 
arid  directly  accessible  to  the  rays,  good  results  might  be 
looked  for.  The  use  of  the  Roentgen  rays  in  cases  of  this 
kind  requires  considerable  technical  skill.  In  cancer  of  the 
stomach  and  other  deep-seated  structures,  X-ray  treatment 
seems  to  offer  no  encouragement. 

All  authors  admit  and  emphasize  the  wonderful  power 
of  the  Roentgen  rays  in  relieving  the  pain  of  malignant 
disease,  even  if  the  lesion  is  deep-seated. 

In  the  treatment  of  lupus  vulgaris  the  X-rays  are  equal 
to  any  other  agent  and  superior  to  most  modes  of  treatment. 
The  points  in  favor  of  X-ray  treatment  are :  it  is  easily 
given,  is  painless  and  consumes  but  little  time.  The  Fin- 
sen-rays  are  equally  effective  but  require  prolonged  ex- 
posures. In  the  erythematous  variety  of  lupus  X-ray  treat- 
ment does  not  seem  to  be  of  much  avail. 

Splendid  results  by  the  proper  application  of  the  Roent- 
gen rays  have  been  achieved  in  all  the  parasitic  diseases  of 
the  hair- follicles  and  nails  (tinea  tonsurans,  sycosis,  etc.). 
In  many  papular  skin-diseases  the  X-rays  are  of  great 
value.  In  psoriasis  splendid  results  are  frequently  achieved, 
even  in  cases  that  had  resisted  all  other  modes  of  treat- 


554  MODERN  PHYSIO-THERAPY. 

merit.  In  acne  the  X-rays  are  admittedly  of  great  value,  if 
used  properly. 

The  Roentgen-rays  are  probably  the  most  valuable 
therapeutic  agent  in  the  treatment  of  pruritus.  It  is  im- 
material whether  there  is  a  concomitant  skin-lesion  or  not. 
If  there  is,  it  is  favorably  influenced  by  the  X-rays.  Splen- 
did results  have  been  reported  in  all  the  pruriginous  skin- 
afflictions  (anal,  vulvar,  intertrigo,  neurotic,  etc.).  In  these 
respects  the  X-rays  rival  the  high-frequency  currents.  The 
effects  are  attributable  to  the  tonic-stimulant  action  of  the 
X-rays  referred  to  by  the  author  (see  page  297). 

In  a  general  way  the  summary  of  opinion  offered  does 
not  differ  from  the  statements  made  in  the  chapter  on  X-RAY 
THERAPY  (see  page  301).  From  a  biologic  point  of  view 
the  preponderance  of  opinions  seems  to  favor  the  supposi- 
tion that  the  action  of  the  X-rays  is  spent  on  and  in  the 
blood,  more  especially  the  erythrocytes  (red  cells).  It  is 
generally  thought  that  at  first  the  X-rays  cause  an  increase 
in  the  absolute  number  of  white  cells  in  the  cutaneous  cir- 
culation. This  effect  is  noticed  within  eight  to  twelve 
hours  after  the  exposure.  After  twelve  hours  the  number 
of  white  cells  decreases,  especially  if  a  hard  tube  had  been 
used.  During  the  first  twelve  hours  no  appreciable  effect 
is  noticed  on  the  red  blood-cells.  After  the  first  twelve 
hours  many  red  blood-cells  appear  broken  up.  The  hema- 
globin  gradually  diminishes  in  quantity.  In  cases  where 
the  red  corpuscles  are  thus  affected  even  after  one  exposure, 
a  therapeutic  reaction  usually  follows,  i.  c.  devitalization 
of  morbid  tissue  and  a  coincident  tendency  towards  granu- 
lation. In  these  rapidly  yielding  cases  pigmentation  of  the 
cuticle  does  not  usually  occur.  In  the  negro  the  therapeutic 
effect  is  not  infrequently  associated  with  disintegration  of 
skin-pigment,  resulting  in  the  appearance  of  permanent 
blanched  blotches.  If  the  action  of  the  X-rays  could  in 
every  case  be  with  certainty  foretold  in  connection  with  the 
relative  degree  of  resisting  power  of  skin-pigment,  the  at- 
tempts to  turn  negroes  white  could  be  made  with  a  reason- 
able amount  of  success  and  without  any  damage  to  the  sys- 
tem at  large. 


GENERAL  INDEX. 


Abdominal   congestions,    104-105. 

Ableitendes  Verfahren,   103. 

Abortion,   justifiable,   480. 

Abscess.      See    Sepsis. 

Absorption,  98,   176. 

Adrenalin-cataphoresis,   442. 

Acne,  257,  326,  501,  553. 

Acne   rosacea,  236,  326. 

Actinic   rays,   161. 

Actinium,   541. 

Active   movements,   128. 

Acute   infections.     See   Fever. 

Affusion    (  Kneipp-douche),    105. 

After-dinner  nap,  64. 

Agalactia,   449. 

Alliers-Schoenberg,    285. 

Alcohol,  78-79. 

Alcoholism,    347. 

Alopecia,   347. 

Alopecia  areata,    169,  347. 

Alternating  currents.    190. 

Amenorrhca,  348. 

Amperage,   185,  218. 

Anal   fissure,  348. 

Anemia,  257,  348. 

Aneurysm.    aortic,    349. 

Aneurysm,   cirsoid,  236. 

Angina,    104. 

Angina  pectoris,  349. 

An.uioma,   236,   3oO. 

Animal  kingdom,  67. 

Animal   magnetism,    120.155.330, 

339,  419. 

Ankle  sprained,   122. 
Ankylosis,    503. 
Anodai   axis,   277. 
Anodal   electrolysis,   235. 
Anode,  259. 

Anorexia.     See   Dyspepsia. 
Anteflexion,  231.  404. 
Ante-version,    551. 
Anthrax,    168. 
Anti-cathode.    260. 
Aphasia,   350. 
Aphonia,  350. 
Apoplexy,   104,  414. 


Apostoli's  method,  238,  404. 
Appendicitis,    105,  350. 
Applied   physiology,   38. 
Arc-light,   161,   180. 
Arterio-sclerosis,  351. 
Arthritis.    See  Stiff  Joints.   Bier's 

Stasis.      Tuberculosis     of 

Joints. 

Arthritis   deformans,   494. 
Asiatic  cholera,  bacillus  of,   168. 
Asphyxia,  351. 
Asthma,  351. 
Atavism,  19,  438. 
Atheromatous    vessel-walls,    104. 

110,  125,  351. 

Atmospheric    pressure,    248. 
Atrichiasis.     See   Alopecia. 
Atrophic  paralysis,  471. 
Atrophy,  143,  247. 
Aufrecht's   experiments,    160. 
Auto-conduction    cage,    226. 
Auto-intoxication,   50,    104,  352. 
Auto-suggestion,   331. 

Bacteria,  22,  46,  47,  160,  168,  322, 
453,  475,  530. 

Bacteriology,   47. 

Bacterium  coli  commune,   168. 

"Baking,"    110. 

Baldness,  169,  347. 

Barber's   itch.     See   Sycosis. 

Basedow's  disease.  See  Exoph- 
thalmic goitre. 

Beck's    tubular    diaphragm,    307. 

Becquerel   rays.   540. 

Bell's  palsy,  540. 

Bier's  method,  93,  352,  495.  516. 

Biliary  Calculi.     See  Calculi. 

Biliousness.  See  Auto-intoxica- 
tion. Dyspepsia.  Jaundice. 

Billroth,   36. 

Bi-polar  electrode,  230-231. 

Birth-marks.  236.   357.   550. 

Bladder,  inflammation  or  ca- 
tarrh of,  381. 

Bloch   on    high    frequency.   254. 


556 


(IKXKKAL  INDKX. 


Blood-purifier,  33. 

Blood-spitting,   413. 

Blue  light,  172-175,  181. 

Boas  on  massage,  123. 

Boas    on    diet    in    constipation, 

374. 

Bone-setting,    114. 
Bony  growths,  239,  269,  273. 
Bouchard,    SO. 
Bowel-function,   48. 
Bowels,   congested,    104. 
Braidism,   339. 
Brand's     water-treatment,     534- 

536. 

Brandt's  massage,  35,   126,  472. 
Breast,  cancer  of,  326,  431,  553. 
Breast,   function  of  female,  449. 
Breeze,    static,   213-214. 
Bright's   disease,    101,    112,   357. 
Bronchitis,   366. 
Bruise,      101,     367.       See     Blue 

Light. 

Bubo.      See   Sepsis,    Syphilis. 
Buechner,    Ludwig,   40. 
Bulbar  paralysis,  471. 
Buttermilk    in    rheumatism,    490. 

Calculi,  368. 

Caldwell's  tube,  324. 

Calories,  75. 

Cancer,  326,  369,  408,  551. 

Carbuncle,    169. 

Carcinoma.     See  Cancer. 

Carnivora,  67. 

Catalysis,   234. 

Cataphoresis,  210,  234,  240,  435. 

Catarrh,  426,  449. 

Catarrhal  state,  426. 

Catchin^   cold,   96. 

Cathodal  electrolysis,  236. 

Cathode,  259. 

Causal  symptoms,  24. 

Causes  of  disease,  21-22,  40-41, 

50,  77. 

Cedergreen,  208. 
Central   stimulation,    143. 
Cephalalgia.      See   Headache. 
Cerebral  hemorrhage,   104,  414. 
Chancre,  370. 
Chancroid,   370. 
Charcot,  339,  441,  482. 
Chemical    effects    of    electricity, 

229. 
Chemical    sources   of    electricity, 

187. 
Chemistry  of  foods,  73. 


Chest-massage,    521. 

Chilblains,  370. 

Chloasma,   438. 

Chorea,   342,   370. 

Christian    Scientists,    334. 

Chromo-therapy,    178,   482. 

Cicatrices,  237. 

Cirsoid   aneurysm,   236. 

Clap.     See   Gonorrhea. 

Clothing,  44. 

Coal-tar   products,   31,  402. 

Cocaine,  240. 

Cohen,  61,  538. 

Coil   and   double   resonator,  222. 

Cold,  82. 

Cold  in  the  head,  449. 

Colic.     See    Enteritis.      Pain. 

Colon   irrigation,  371. 

Color,  effects  of,   178,  482. 

Colors,  oo,   178. 

Comedo,  501. 

Comma  bacillus,  168. 

Compressed  air,  369-370. 

Compression    (Bier),    353. 

Concentric  movements,    128. 

Condensed  air.  See  Compressed 
air. 

Condensation-couch,  223. 

Conductors,   185. 

Congestion,  93,  96,  106,  247. 

Conjunctivitis.  See  Inflamma- 
tion. 

Conjunctivitis,    ultra-violet,    253. 

Conservative   surgery,   36. 

Constant  current.  See  Galvanic 
current. 

Constipation,  49,  138,  372. 

Contusion,   101,   174,  367. 

Convection,  206. 

Copper-electrodes,    239. 

Copper  oxy-chloride,  239,  434, 
444. 

Corns,  379. 

.Corset,    41. 

Cough,  379. 

Coulomb,  185. 

Cupric  electrolysis,  235. 

Curie,   Pierre,  and  wife,  540. 

Currents,    190,    193. 

Cutis  anserina,  90,  99. 

Dandruff,  382. 

D'Arsonval,  221,  252,  256-257. 
D'Arsonvalization,  258. 
Darwin,  19,  68,  496. 
Deafness,  382. 


GENERAL  INDEX. 


557 


Degeneration,   19,   56,   143. 

Debierne,  541. 

"Derivating"    method,    103. 

Derivation,   103,  382. 

Dercum,  340. 

Dermo-lamp,   167. 

Destructive    action    of    current, 

229. 

Developing  fluid,  297. 
Diabetes   insipidus,   382. 
Diabetes   mellitus,  383. 
Diagnosis,  20. 

Diagram   of   induction   coil,    182. 
Diagram  of  magnetic   Held,  227. 
Diaphoresis,  97. 
Diarrhea,    385. 
Diasolenic     cylinder,     220,     226, 

257. 

Dielectric,   207. 
Dietetics,  26,  59. 
Diet  for  the  sick,  72,  386. 
Digestive  process,  62. 
Dilated   capillaries,   236. 
Dilated  stomach,  73. 
Diphtheria-bacillus,   160 
Diphtheritic   paralysis,  471. 
Direct   current,    190. 
Disease  defined,    18-20. 
Disruption,    207. 
Disturbances   of   nutrition,   27. 
Donovan's   solution,  431. 
Double   resonator,  222. 
Dowie,  J.  A.,  336. 
Drinking  water,  51. 
Drug-action.   16,  30-32,  484,  548. 
Drug-habits,  386. 
Drugs,  30,  39,   108,  387,  476. 
Dry  heat,   1C8. 
Dubois-Raymond,  88. 
Dysentery,  388. 
Dysmenorrhea,  216,  388. 
Dyspepsia,   388. 

Eccentric   movements,    128. 

Eczema,    169,  2s7,  326,   501. 

Eddy,   Mrs.,  336. 

EfHeurage,   118. 

Electrical  terms,   183,   192. 

Electricity  defined,    184. 

Electric  Light  Bath,   176,  362. 

Electro-cautery,  397. 

Electro-chemical   effects.  234. 

Electrodes,  faradic  and  gal- 
vanic, 197.  199,  201,  241. 

Electrodes,  high  frequency,  224- 
225. 


Electrolysis,   235. 

Electro-mechanics,    183. 

Electro-physics,    183. 

Electro  -  therapeutic  currents, 
192. 

Emphysema,  397. 

Empirical   methods,  28. 

Empirical   therapy    16. 

Emunctories,  40. 

Enchondroma,  239,  269. 

Endometritis,  398,  432. 

Endosmosis,  cutaneous,  89. 

Enlarged  tonsils,  400. 

Enteric  fever.  See  Typhoid 
fever. 

Enteritis,  400. 

Epididymitis.  See  Orchitis.  In- 
flammation. 

Epilepsy,  53,  342,  400. 

-Epithelial    hypertrophies,    238. 

Epithelioma,  326,  328,  551. 

Epistaxis,  413. 

Esmarch's  antisepsis,   160. 

Ether,   151. 

Ethereal   molecule,    151. 

Ethics  of  food,  65. 

Ewald's    salol    experiment,    122. 

Exanthematous    diseases,   402. 

Excentric  (eccentric)  move- 
ments, 128. 

Excretory  organs,  21. 

Exercise,  114. 

Exophthalmic  goitre,  410. 

Exostosis,  239,  269,  273. 

Explosion  of  coil  or  tube,  310- 
311. 

External  medication,   31. 

Exudates,    105,  434,  472. 

Eyelids,    granulated,   412. 

Facial  neuralgia,  453. 

Facial  paralysis,  471. 

Faraday's   experiment,   191. 

Faradic  current,   193,  242. 

Faradism,    i93,  242. 

Faradic  coil,  201. 

Fatty  heart,  401. 

Favus,  327. 

Fever,  27,  87,  401,  534. 

Fibroid  tumors,  238,  403. 

Fibroma,  238. 

Fifth  nerve,  453. 

Finsen,    Niels   R.,    161,   319,   444, 

495,  £01. 

Fistula  in  ano,  404. 
Flexions  of  the  womb,  404. 


GENERAL  INDEX. 


Fluoroscope,    265. 

Fluoroscopy,  uses  of,  266. 

Fraenkel's    movement-cure,    440. 

Freckles,  405. 

Frequency,  low,  high,  255. 

Freund   en   high   frequency,  256. 

Food  defined,  60. 

Force,   150. 

Force-modalities,    150. 

Friction,   118. 

Frictional    electricity.    See   static 

electricity. 

Friction-machine,   203. 
Functional    disorders,    405. 
Fungus,  236-238. 
Furuncle,    169,   499. 

Galactorrhea,  449. 

Gall-stones,  266. 

Galvanic  current,    193,   229. 

Galvanic  current,  absorbent  ef- 
fects of,  232. 

Galvanic  current,  action  of  pos- 
itive pole  of,  235. 

Galvanic  current,  action  of  neg- 
ative pole  of,  236. 

Galvanic  current,  anodyne  ef- 
fects of,  232. 

Galvanic  current,  chemical  ef- 
fects of,  234. 

Galvanic  current,  electrolytic  ef- 
fects of,  235-238. 

Galvanic  current,  general  appli- 
cations of,  234. 

Galvanic  current,  interrupted, 
232. 

Galvanic  current,  mild  applica- 
tions of,  233. 

Galvanic  current,  physiological 
effects  of,  219. 

Galvanic  current,  sedative  ef- 
fects of,  232. 

Galvanism,   193,  229. 

Galvanization,   234. 

Gaston's  method,  431. 

Gastralgia,  454. 

Gastric  cancer,  409. 

Gastric  ulcer.  409. 

Gastritis.  409. 

Geisler's  experiments,  52,   160. 

General  paralysis  of  the  insane, 
472. 

Germs.      See    Micro-organisms. 

Gevser's  treatment  of  trachoma, 
"  412. 

Goethe,   30. 


Goitre,  239,  410. 

Goitre,    exophthalmic,   410. 

Gonococcus,    166,  236. 

Gonorrhea,  236,  411.  493. 

Gonorrheal   rheumatism,   493. 

Goose-skin,   90.   99. 

Gout,  412. 

Granger,   430. 

Granulated   eyelids,  412. 

Graves'  disease.  See  Exophthal- 
mic goitre. 

Green   light,   181. 

Ground  wire,  207. 

Gymnastics  of  the  chest,  521- 
524. 

Gynecological  massage,  35.  126, 
472. 

Hammer,  Wm.  J.,  541. 

Hair-follicles,    diseases    of,    553. 

Hair,   superfluous,  236,   327. 

Hard  tube,  264. 

Hay-fever,  351. 

Headache,  28,  104,  117,  234,  341, 
412. 

Health  defined,  18,  247. 

Heart,  fatty  degeneration  of, 
401. 

Heart  and  adnexa,  inflamma- 
tory conditions  of,  473. 

Heart,  palpitation  of,  464. 

Heart,  valvular  diseases  of,  542. 

Heat,  82. 

Heat-stroke,   ICO.   504. 

Helio-pantheism,    154. 

Hematemesis,    414. 

Hemoptysis,    104.  413. 

Hemorrhage,    104-413. 

Hemorrhoids,   416. 

Hepatic  cancer,  416. 

Hepatic  cirrhosis,  416. 

Hepatic  congestion,  104.  See 
Jaundice. 

Herbivora,    68-70. 

Herdman.  W.  J,  512. 

Heredity.   19. 

Herpes,  501. 

Hexenschuss.      See    Lumbago. 

Hiccough,  497. 

High    frequency   apparatus,    218. 

High  frequency  currents,  195, 
25 1.  256-257,  554. 

High  tension   electrodes,  223-22^. 

Hilton's   definition   of   pain,  450 

Hippocrates,  40,  59. 

Homeopathy,   37. 


GENERAL  INDEX. 


559 


Hoorweg  on  high  frequency, 
256. 

Hydrocele,  417. 

Hydro-electric   bath,   389. 

Hydro-faradic   application,?,   243. 

Hydro-galvanic  applications,  241. 

Hydro-therapy,    32,    82. 

Hygiene,  26,  38,  65. 

Hygrometer,  205. 

Hypertrichosis,  236,  327,   501. 

Hypertrophy,   143,  232,  234,  240. 

Hypochondriasis,    417. 

Hysteria,  101-102,  417,  470. 

Ice-applications,    101. 

Impotency.  See  Sexual  weak- 
ness. 

Incontinence  of  urine,  420. 

Indigestion.      See    Dyspepsia. 

Induction,   191,  219. 

Induction   coil,  diagram  of,   182. 

Inertia,   uterine,   541. 

Infantile  paralysis,  471. 

Inflammation,  acute,  420. 

Inflammation,    chronic,    425. 

Influence-machine,    206. 

Influenza.      See   Fever. 

Inoperable  malignant  disease, 
429. 

Insolation,    100,   504. 

Insomnia,  104,  341,  432. 

Instrumental    massage,    132. 

Instrumental    movements,    132. 

Insulation,   185. 

Intercostal  neuralgia,  454. 

Interrupted  current.  See  Far- 
adic  current. 

Intestinal    hemorrhage,   415. 

Intestines,  congested,   104. 

Infra-pelvic    inflammations,    432. 

Intra-uterine    electrodes,   230. 

Invisible  rays,   161. 

Jaundice,   catarrhal,   437. 
Joints,  stiff,  503. 

Kant's    Imperativus    categoricus, 

337 

Kassabian,   M.   K.,  301. 
Kattenbracker's         experiments, 

166. 

Kellogg,  111. 
Keloid,  327,  501. 
Keratosis  senilis,  327,  501. 
Kidney-function,   48. 
Kinesi-       (properly 

therapy,    127. 


Kjeldsen's   lamp,   166. 
Kneipp,  49,  105-106,  108,  442. 
Koumiss,   409. 
Kraftumwerthung,    55,    154. 

Laboratory-methods,   395. 

Laryngitis.      See    Tonsillitis. 

Lateral  sclerosis,  437. 

Lead  poisoning.  See  Constipa- 
tion. Paralysis. 

Lenstrom's    experiments,    245. 

Leucorrhea,   437. 

Leukemia,  327. 

Leyden   jars,  209. 

Lichen  planus,  327,  501. 

Light,   158. 

Light,  biologic  importance  of, 
159. 

Light,  germicidal  effects  of,  160, 
168. 

Light,  physics  of,  161. 

Line   of   rest,    153. 

Ling,  P.  H.,  117,  127. 

Liver,  cancer  of,  416. 

Liver,  cirrhosis  of,  416. 

Liver,   congestion   of,   104. 

Liver-spots,  438. 

Locomotor  ataxia,  342,  438. 

Lombroso,   56. 

London   Hospital  lamp,   166. 

Lues.     See   Syphilis. 

Lumbago,  36,  138,  454,  494. 

Lung-exercise,   524. 

Lung- fever,  475. 

Lung-function,  45. 

Lungs,  congestion  of,   104,   105. 

Lupus  erythematosus,  257,  328, 
444,  501,  555. 

Lupus  vulgaris,  236,  327,  444, 
502,  553. 

Maggiora  on  massage,  124. 

Magnetic  field,  diagram  of,  227. 

Magnetism,   183. 

Malaria,  445. 

Malignant     disease,     inoperable, 

429. 

Marriage   of   consumptives,   525. 
Massage,  34,  114,  117. 
Massage  of  the  chest,  521. 
Massage  of  the  stomach,  393. 
Massey's  method,  240,  434,  444. 
Mastitis,   449. 
Mastkur,   418. 

Mastoiditis.     See  Inflammation. 
Maternal   impressions,   334. 


560 


GENERAL  INDEX. 


McCaskcy,  G.  W.,  513. 

Moat,  66. 

Meat,   relation   to  cancer,   432. 

Mechanical  sources  of  electric- 
ity, 188. 

Mechano-therapy,    114. 

Melancholia,  446. 

Meningitis,   104,  447. 

Menorrhagia,  236,  415,  448. 

Mental  disorders,  343. 

Mercury  in  lues,  510. 

Mesmerism,  339. 

Metallic  electrolysis,  239,  434, 
444. 

Metritis,  429,  448. 

Metrorrhagia,  236,  415,  448. 

Metschnikoff,  50,  408,  458. 

Metzper,  Prof.,  117. 

Micrococcus    gonorrhoicus,    168. 

Micrococcus    prodigiosus     541. 

Micro-organisms,  22,  46,  47,  160, 
168,  322,  475,  530,  541. 

Migraine,  448. 

Milk-secretion,  449. 

Milliamperemeter,   193. 

Milzbrand,  160. 

Mind  control,  333. 

Minin,  111,  171    371. 

Mitchell,  Weir,  377,  418,  441,. 
470. 

Mogigraphia.  See  Writer's 
Cramp,  under  Occupation- 
neuroses. 

Moles,  236,  449. 

Moleschott,  154. 

Monell,  216. 

Morton  wave  current,  217,  247, 
250. 

Movement-cure,  127,  440. 

Music,  56,  483. 

Myalgia.  See  Rheumatism,  mus- 
cular. 

Nails,  diseases  of,  553. 

Nasal  catarrh,  449. 

Nasal  septum,  239. 

Nature's  be.dside  method,  23. 

Nauheim  carbonated  baths,  546. 

Nauheim  massage,  545. 

Negative  electrolysis,  236. 

Negatives,  294-295. 

Negroes,  pigment  in  the  skin  of, 

170,  554. 

Neiswanger,  248,  417,  550. 
Nervous  diseases,  450. 
Nervousness,  101,  216,  454. 


Nervous   system,   140. 

.\\-phritis.  101,  112,  357. 

Neuralgia,  341,  450. 

Neuralgia,  facial,  233,  453. 

Neurasthenia,  216,  234,  343,  454, 

Neurosis,  case  of  gastric,  34. 

Newman's  method,  237,  480. 

Night-sweats,  456,  520. 

Non-destructive  action  of  cur- 
rents, 229. 

Non-reactive  water-applications, 
107. 

Nnrdau,    Max,   56. 

Nose-bleeding,   413. 

N-rays,    157. 

Nutrition,   27,  90,    144. 

Obesity,  108,   132,  243,  456. 

Occupation-neuroses,  457. 

Odontalgia,  453.  515. 

OerteFs  method,  387.  398,  456, 
542,  548. 

Ohm's  law,   186. 

Operative  surgery,  37. 

Opsonic  therapy,  458. 

Orchitis,  464. 

Organs  of  special  sense,  54 

Orthopedics,  114. 

Oscillation,   115,   149. 

Oscillator,  147. 

Osteoma,  239. 

Osteopathy,  115,  142. 

Otitis.  See  Inflammation.  Deaf- 
ness. 

Oudin  resonator,  223. 

Ovarian  neuralgia,  454. 

Oxidation,  59,  86,  129,  235. 

Oxygen,  45,  46.  159,  322,  499,  527. 

Ozone,  250,  528. 

Pain,   24,   29,   35,    124,    171,    175, 

217,  233,  24r,  464 
Palpitation  of  the  heart,  464. 
Fapilloma,  238,  472. 
Papular  skin  diseases,  553. 
Paralysis,  232,  341,  464,  470,472. 
Paralysis,  different  forms  of,  471. 
Paresis.     See   Paralysis 
Parametritis,   \32. 
Passive  movements,   128 
Pelvic  adhesions,  472. 
Pelvic  cellulitis,  432. 
Pelvic  exudates,  434,  472. 
Pericarditis,  473. 
Perimetritis,  432. 
J  Vritonitis,   1U5.  474. 


GENERAL  INDEX. 


5rl 


Fetrissage,    113. 
Pettenkofer,  52,  79,  158. 
Phagocytosis,  246,  458,  479. 
Pharyngitis,  474. 
Photography,  268,  294. 
Physics  of  electricit/,   184. 
Physics  of  light,  160. 
Physics  of  X-rays,  3(1 
Physiological  methods,  .^2  . 
Physio-therapy  define-!,   i.x 
Piffard's  cataphoresis,  442. 
Piffard  rays,  474,  550. 
Pigment,  170,  318,  550.  554. 
Piles,  416. 
Pitchblende,   540. 
Placebo,  334. 

Plasmodium,   170,  246,  445. 
Pleurisy,  475. 
Pleurodynia,  486,  493. 
Plexus,    141. 
Plumbism.       See      Constipation. 

Paralysis. 
Pneumatic    cabinet    or    chamber. 

See   Compressed  air. 
Pneumonia,  105,  475. 
Point  of  rest,  153. 
Poisons,  32. 

Polarity,  192,  2CO,  207,  244. 
Pole-changer,  208. 
Polonium,  541. 
Polypus,  236. 
Pope,  Curran,  348. 
Positive  electrolysis,  285. 
Post-diphtheritic  paralysis,  471. 
Potential  alternations,  214-217. 
Premature  labor,  480. 
Prevalent  ideas,  332. 
Priessnitz,  25.  84,  93.  95,  98,  102, 

106,  422,  501,  534. 
Primary   area   in   hydro-therapy, 

92. 

Proctitis.     See  Inflammation. 
Progressive     muscular     atrophv, 

471. 

Prostate  gland,  enlarged,  480. 
Pruritus,     328,     502,     554.      See 

Auto-intoxication. 
Psoriasis,  169,  257,  501,  533. 
Psychic  disorders,  343. 
Ptomaine-poisoning.     See  Auto- 
intoxication. 
Pus-germs.     See  bacteria. 

Radio-activity,   155,  315,  540. 
Radiography,  267. 
Radio-therapy,   313. 


Radium,  541. 

Rarefied  air.    See  Compressed  air. 

Rationale  of  disease,  23. 

Rationale  of  symptoms,  23. 

Rationale   of   treatment,   26. 

Raw  food,  77. 

Reaction    in    hydro-therapy,    91, 

94,  110,  487. 

Reactive   water-applications,   102. 
Recreation,  511. 
Red  light,  163,  178. 
Reflex  disorders,  480. 
Resistance,   185. 
Resistance-movements,    128. 
Resonance-effects,  221. 
Rest-cure,  377,  511. 
Restorative  symptoms,  24. 
Retention  of  urine.  See  Cystitis. 

Reflex  disorders. 
Retroflexion,  230,  404. 
Rheumatism,  35,  70,  101,  112,  128, 

484. 

Rheumatism,  muscular,  493. 
Rheumatoid  arthritis,  494. 
Rhinitis,  449. 
Rock-crystal,   164. 
Roentgen-rays.     See   X-rays. 
Rokitanski,   516. 
Roller-cabinet,    196. 
Roman-Irish     (dry    heat)    bath, 

/JS. 
Russian    bath    (hot    steam    barh 

followed     by     douche     and 

massage).      See    hyJro'chor- 

apy. 

Salpingitis,  432,  495. 

Sarcoma,  240,  328,  49^ 

Scars,  162,  237. 

Scheidel  coil,  explosion  of,  311. 

Schroth,   Johann,   408,   409,   411, 

490,  507. 

Schueller's    ernerimepfs   ()1. 
Schwedische  Heilgymnastik,  127. 
Sciatica,  243,,  454. 
Scleroderma  pigment  >sij>n,  502. 
Sclerosis,  437-438. 
Secondary    area    in     hydroiher- 

apy,  92. 

Secondary  radiations,  2^3. 
Sepsis,  495. 

Sex-determination,    -tOfi. 
Sexual   instinct,  56. 
Sexual   weakness,    147,    ISM,   206, 

497. 
Shunt,  1?G. 


562 


(  iK.XKKAI.     I.XDK.X. 


Singultus,   497. 

Sinusoidal   current,    195. 

Skeleton  of   static  m^chin-.-,  3)4. 

Skiagraphy.  267. 

Skin-clisea"si-s.   369,  -HJ9,  4'V. 

Skin-fi  nction,   42. 

Skinner,  C.  E.,  491. 

Smallpox,  scars  of,  162. 

Snow,   Arnold,  443,  452. 

Snow's  electrodes,  2^6. 

Soft  tube,  -64. 

Solarium,   171. 

Spasm,  502. 

Species,   18. 

Spinal  cord,   140. 

Sprains,   101,  112,  502- 

Spray,  static,  207. 

Static   applications,  210. 

Static    electricity,    194,   202,    244, 

250. 

Static  induced  current,  214,  215. 
Static  machine,  202,  204. 
Static    machine,    how     to    clean, 

203. 

Static  machine,  how  to  dry,  203. 
Static  machine,  polarity  of,  207. 
Steam-bath,  107. 

Steam-bath  for  fever  cases,  403. 
Stenosis.  503. 
Stereo-skiagraphy,    301. 
Stiff  joints,  503. 
Stitch  in  the  side,  475,  531. 
Stomach,  catarrh  of.     See   Dys- 
pepsia. 
Stomach,   inflammation   of.     See 

Gastritis. 

Stomach-massage,  393. 
Stone.     See  Calculi. 
Streptococcus  pyogenes,  168. 
Strictures,   503. 
Strictures,  urethral,  237,  504. 
Stuttering,  343. 

St.  Vitus'  dance.     See  Chorea. 
Suction   (Bier),  353. 
Suggestion,    156,    157,    251,    330, 

481. 
Suggestive     element     in      static 

electricity,  251. 
Sunbath,   170. 
Sunlight,   161,   170. 
Sunstroke,   100,  504. 
Superfluous  hairs,  236,  327,  506. 
Surgery,     conservatism     in,     36, 

240. 

Surging,  214. 
Survival  of  the  fittest,  18,  19. 


Suspension  method  in  tabes,  441. 
Sweat,  97. 

Swedish   movements,    127. 
Swimming  for  consumptives,  524. 
Sycosis,  169,  502,  553. 
Sympathetic   nerves,    141,    144. 
Syphilis,  5C6. 

Tabes  dorsalis,  438. 

Table-plate,  faradic-galvanic,  182. 

Tait,  Lawson,  35. 

Tangential  rays.  2S3. 

Tapotement,    188. 

Testicles,  inflammation  of.  See 
Orchitis. 

Tetanus,  511. 

Therapy  of  rlectric  currents,  228. 

Therapy  of  light,  158. 

Therapy  of  water,  99. 

Therapy  of  Roentgen-  (X-) 
rays,  313. 

Thorium,  541. 

Tic-douloureux,  453. 

Tinea  circinata,  502. 

Tinea  tonsurans,  236.  328,  553. 

Tissue-builders,  61. 

Tissue-consumers,  61. 

Tobacco,  62,  514. 

Tonsils,  enlarged,  400. 

Tooth-ache,  453,   515. 

Torticollis,  36,   138,  486,  493. 

Trachoma,  412. 

Tripet  on  high  frequency,  256. 

Trockenkur.  See  Schroth,  Jo- 
ham. 

Tubercle  bacillus,  47,  160,  168, 
170,  322,  519. 

Tuberculosis,  47,  328. 

Tuberculosis  as  an  economic 
problem,  48,  532. 

Tuberculosis  of  glands,  515. 

Tuberculosis  of  joints,  516. 

Tuberculosis  pulmonum,  517,  355. 

Tumors.  232,  234-240,  313. 

Typhoid  fever,  24,  52,  84,  534. 

Typhoid  fever,  relation  of  water 
to,  51. 

Ulcer,  533. 

Ulcer,  gastric,  409. 

Ultra-volet  element  in  high  fre- 
quency, 253. 

Ultra-violet  element  in  X-rays. 
316. 

Ultra-violet  rays,  161,  251,  253, 
283,  318. 


GENERAL  INDEX. 


563 


Undulation   151. 

United  States,  climate  of,  538. 

Uranium,   540. 

Uremia,   541. 

Urethral    stricture,   504. 

Urethritis.   specific,  411. 

Uterine  fibroids,  238. 

Uterine  hernorrhage,  415. 

Uterine   inertia,  541. 

Vacuum   electrodes,   224. 
Vacuum  of  the  X-tube,  261,  279. 
Vaginismus,  542. 
Valvular   diseases   of   the   heart, 

542. 

Vapor-bath,   107,_  402. 
Varicose  veins,  549. 
Varix,  236,  550. 
Vascular   tumors,  236,   551. 
Vegetarian  diet,  67. 
Versions  of  the  womb,  551. 
Vertigo.     See  nervous  disorders. 

Constipation,    Dyspepsia. 
Vibration,  115,  136. 
Vibration-tables,    145-147,  466. 
Vibrator}'  stimulation,   142. 
Vis  medicatrix  naturae,  18,  507. 
Voltage,  184,  186. 
Vomiting  of  pregnancy,  233,  551. 

Wagner,  Richard,  55,  57. 

Walter's  radiations,  283,  317. 

Walter's   skiameter,  304. 

Warts,  236,  238. 

Water  as  a  physiological  ele- 
ment, 61. 

Water,  hygienic  importance  of, 
51. 

Water-applications,  different 
kinds  of,  100. 


Water— applications,  physiologi- 
cal effects  of,  85. 

Wave-length,   152. 

Wetterstrand,  343. 

Will-power,  332. 

Wine-marks.      See    Birth-marks. 

Winternitz,  Prof.  Wilhelm,  88, 
92,  95,  122,  176,  249,  478. 

Wounds,  178. 

Wright,  458. 

Wrist-drop.     See    Paralysis. 

Writer's  cramp.  See  Occupa- 
tion-neuroses. 

Wry-neck.     See  Torticollis. 

X-rays       (Roentgen-rays),    258, 

313. 

X-rays,  anodyne  effects  of,  553. 
X-rays  in  biology,  320. 
X-rays,  physics  of,  314. 
X-rays,    ultra-violet    element    in, 

316. 

X-ray  accessories,  303. 
X-ray  burns,  307,  551. 
X-ray  camera,  285. 
X-ray  coil,  portable,  551-552. 
X-ray  diagnosis,  258. 
X-ray  errors,  298. 
X-ray  gloves,  311. 
X-ray  statistics,  551. 
X-ray  therapy,  313. 
X-ray  tubes,  258. 

Zander's   method,    134. 
Ziegenspeck,   126. 
Zinc-mercury  cataphoresis,  431. 
Zinc  silicate,  254. 
Zone  of  sterilization,  430. 
Zoroaster,   154. 


DATE  DUE 


PRINTED  IN  U   S 


3   1970  00592  4599 


UJ 


LU 

ca 


